Small interfering RNA (siRNA) has a promising future in the treatment of ocular diseases due to its high efficiency, specificity, and low toxicity in inhibiting the expression of target genes and proteins. However, due to the unique anatomical structure of the eye and various barriers, delivering nucleic acids to the retina remains a significant challenge. In this study, we rationally design PACD, an A-B-C type non-viral vector copolymer composed of a hydrophilic PEG block (A), a siRNA binding block (B) and a pH-responsive block (C). PACDs can self-assemble into nanosized polymeric micelles that compact siRNAs into polyplexes through simple mixing. By evaluating its pH-responsive activity, gene silencing efficiency in retinal cells, intraocular distribution, and anti-angiogenesis therapy in a mouse model of hypoxia-induced angiogenesis, we demonstrate the efficiency and safety of PACD in delivering siRNA in the retina. We are surprised to discover that, the PACD/siRNA polyplexes exhibit remarkable intracellular endosomal escape efficiency, excellent gene silencing, and inhibit retinal angiogenesis. Our study provides design guidance for developing efficient nonviral ocular nucleic acid delivery systems.

Objective: To understand the trends in malnutrition among primary and middle school students of Han nationality in Hainan Province from 2005 to 2019, so as to provide a basis for improving nutrition intervention measures for children and adolescents. Methods: A sample of 32 949 Han nationality primary and middle school students aged 7-18 years old in Hainan Province were investigated in 2005, 2010, 2014 and 2019 based on national survey on student physical fitness and health. The Malnutrition Screening Standard of Schoolage Children and Adolescents was used to screen malnutrition. Statistical analysis was performed using the χ2 test and the χ2trend test. Results: In the four surveys conducted during 2005 to 2019, the prevalence of malnutrition among primary and middle school students were 22.12%, 18.80%, 15.89% and 9.56%, respectively, with an increase of -12.56% and an average annual increase of -5.82%. The decreasing trend of malnutrition by year was statistically significant (χ2trend=600.72, P<0.01), and the proportion of emaciation type was the highest (8.87%-20.15%). The detection rates of malnutrition among all students aged 7 to 18 showed a decreasing trend from 2005 to 2019 (χ2trend=56.44, 60.04, 61.48, 42.49, 51.81, 50.81, 72.86, 101.34, 86.38, 24.81, 17.72, 10.38, P<0.01). From 2005 to 2019, the detection rates of malnutrition in boys were higher than that of girls (in 4 surveys), and that in rural students from 2005 to 2014 of 3 surveys were higher than that in towns (χ2=92.07, 35.16, 25.29, 29.98; 64.35, 4.26, 6.32, P<0.05). Conclusions The malnutrition of Han nationality primary and middle school students aged 7-18 years in Hainan Province show a trend of improvement year by year from 2005 to 2019, despite the overall high detection rate. Wasting is the most common type of malnutrition. The epidemic of malnutrition varies by age, sex and areas. Further targeted measures should be taken to strengthen intervention in the diet of primary and middle school students, to improve the nutritional status of children and adolescents.

Objective:To explore the long-term efficacy of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease (GERD).Method:Clinical data of proton pump inhibitor dependent GERD patients who underwent fundoplication at the Rocket Force Characteristic Medical Center from Jan to Jun 2012 were analyzed, including GERD symptom score, subjective symptom relief rate, PPI discontinuation rate and surgical satisfaction, as well as recurrence and complications.Result:A total of 160 GERD patients were included in this study, with 64% of patients having respiratory symptoms. Nissen and Toupet fundoplication were performed in 43 and 117 cases, respectively, with a follow-up time of (127±3) months. The postoperative GERD symptom scores of the patients were significantly lower than before treatment (all P<0.001); The subjective relief of overall symptoms in the digestive tract and airway problem was 90% (80%, 100%) and 100%, respectively. The PPI discontinuation rate was 86%, and the overall satisfaction rate of the treatment was 92%, and the satisfaction rate of patients with respiratory symptoms was 89%. 7% of patients experienced varying degrees of symptomatic recurrence, 4% of patients re-underwent endoscopic treatment and/or laparoscopic fundoplication due to symptom recurrence. The incidence of long-term postoperative dysphagia, bloating, belching, increased exhaust, abdominal pain, diarrhea, and constipation were 11.3%, 16.9%, 0, 1.3%, 0, 2.5%, and 5.6%, respectively. Conclusions:Laparoscopic fundoplication has good long-term efficacy in the treatment of GERD. A small number of patients may experience postoperative recurrence, as well as complications such as dysphagia and gas-bloat syndrome. Most recurrent patients can achieve good therapeutic effect by redoing endoscopic treatment or redoing surgery.

Coronavirus disease 2019 (COVID-19) has been a pandemic for more than a year.With the expanding second wave of the pandemic in winter,the continuous evolution of SARS-CoV-2 has brought new issues,including the significance of virus mutations in infection and the detection of asymptomatic infection.In this review,we first introduced several major SARS-CoV-2 mutations since the COVID-19 outbreak and then mentioned the widely used molecular detection techniques to diagnose COVID-19,primarily focusing on their strengths and limitations.We further discussed the effects of viral genetic variation and asymptomatic infection on the molecular detection of SARS-CoV-2 infection.The review finally sum-marized useful insights into the molecular diagnosis of COVID-19 under the special situation being challenged by virus mutation and asymptomatic infection.

The monitoring of pregnant women is very important. It plays an important role in reducing fetal mortality, ensuring the safety of perinatal mother and fetus, preventing premature delivery and pregnancy accidents. At present, regular examination is the mainstream method for pregnant women's monitoring, but the means of examination out of hospital is scarce, and the equipment of hospital monitoring is expensive and the operation is complex. Using intelligent information technology (such as machine learning algorithm) can analyze the physiological signals of pregnant women, so as to realize the early detection and accident warning for mother and fetus, and achieve the purpose of high-quality monitoring out of hospital. However, at present, there are not enough public research reports related to the intelligent processing methods of out-of-hospital monitoring for pregnant women, so this paper takes the out-of-hospital monitoring for pregnant women as the research background, summarizes the public research reports of intelligent processing methods, analyzes the advantages and disadvantages of the existing research methods, points out the possible problems, and expounds the future development trend, which could provide reference for future related researches.
Female ; Fetus ; Humans ; Pregnancy ; Pregnant Women

BACKGROUND/AIMS: MicroRNAs (miRNAs) were reported to be responsible for intestinal permeability in diarrhea-predominant irritable bowel syndrome (IBS-D) rats in our previous study. However, whether and how miRNAs regulate visceral hypersensitivity in IBS-D remains largely unknown. METHODS: We established the IBS-D rat model and evaluated it using the nociceptive visceral hypersensitivity test, myeloperoxidase activity assay, restraint stress-induced defecation, and electromyographic (EMG) activity. The distal colon was subjected to miRNA microarray analysis followed by isolation and culture of colonic epithelial cells (CECs). Bioinformatic analysis and further experiments, including dual luciferase assays, quantitative real-time polymerase chain reaction, western blot, and enzyme-linked immunosorbent assay, were used to detect the expression of miRNAs and how it regulates visceral hypersensitivity in IBS-D rats. RESULTS: The IBS-D rat model was successfully established. A total of 24 miRNAs were differentially expressed in the distal colon of IBS-D rats; 9 were upregulated and 15 were downregulated. Among them, the most significant upregulation was miR-200a, accompanied by downregulation of cannabinoid receptor 1 (CNR1) and serotonin transporter (SERT). MiR-200a mimic markedly inhibited the expression of CNR1/SERT. Bioinformatic analysis and luciferase assay confirmed that CNR1/SERT are direct targets of miR-200a. Rescue experiments that overexpressed CNR1/SERT significantly abolished the inhibitory effect of miR-200a on the IBS-D rats CECs. CONCLUSIONS: This study suggests that miR-200a could induce visceral hyperalgesia by targeting the downregulation of CNR1 and SERT, aggravating or leading to the development and progression of IBS-D. MiR-200a may be a regulator of visceral hypersensitivity, which provides potential targets for the treatment of IBS-D.
Animals ; Blotting, Western ; Colon ; Computational Biology ; Defecation ; Diarrhea ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Hyperalgesia ; Hypersensitivity ; Irritable Bowel Syndrome ; Luciferases ; Microarray Analysis ; MicroRNAs ; Models, Animal ; Permeability ; Peroxidase ; Rats ; Real-Time Polymerase Chain Reaction ; Receptors, Cannabinoid ; Serotonin Plasma Membrane Transport Proteins ; Serotonin ; Up-Regulation

Objective To evaluate laparoscopic π-shaped esophageal jejunostomy vs.laparoscopic assisted end-to-side esophageal jejunostomy in]D2 radical total gastrectomy for middle third gastric cancer.Methods From July 2015 to July 2017,154 patients undergoing laparoscopic D2 radical total gastrectomy were divided into group of laparoscopic assisted end-to-side esophageal jejunostomy (92 cases) and the group of totally laparoscopic π-shaped esophageal jejunostomy (62 cases).Results The group of totally laparoscopic π-shaped esophageal jejunostomy was not statistically different in tumor pathology and postoperative complications with laparoscopic assisted group,but was better than the later in anastomotic reconstruction surgery time (21 ± 3) min vs.(30 ± 3) min,t =17.56,P =0.000,incision length (6.7 ±1.1) cm vs.(10.5 ± 1.7) cm,t =15.72,P =0.000 and anastomotic complications (3％ vs.13％,x2 =4.320,P =0.038).Conclusions Totally laparoscopic π-shape esophageal jejunostomy is safe,feasible,better than hand assisted procedures.

OBJECTIVETo investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction.

METHODSClinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team (MDT) evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared.

RESULTSThere were 30 male and 33 female patients with age of 30 to 90 (mean 67) years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient (1.6%) developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients (16.1%) were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days (7-20 days), including open (n=18, including two cases with conversion to open surgery) and laparoscopy (n=34). The baseline data between open and laparoscopy groups were similar (all P>0.05). Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement [(2.88±1.06) d vs. (4.05±2.43) d, P=0.022] and shorter postoperative hospital stay [(7.85±0.96) d vs. (9.82±4.41) d, P=0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups (all P>0.05).

CONCLUSIONSEndoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.

Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.

Objective:To investigate the cause, treatment, and prognosis of delayed hemorrhage in patients who underwent radical gastrectomy. Methods:The clinical data of 294 patients who underwent radical gastrectomy in the Second Hospital Affiliated from Nanchang University from January 2015 to October 2015 were retrospectively analyzed. Results:A total of 15 patients suffered from delayed hemorrhage and accounted for 5.1%of the gastric cancer cases in our hospital for the same period of radical gastrectomy. Of the 15 patients, 9 underwent laparoscopic radical gastrectomy and 6 received open radical gastrectomy resection. Large vascular hemorrhage was found in 7 cases. Anastomosis and anastomotic ulcer induced hemorrhage were observed in 3 cases. Duodenal stump rupture induced hemorrhage was detected in 2 cases. Hemorrhage was also observed in some parts in 2 cases. Likewise, hemorrhage occurred in 1 case, but the affected parts were unknown. Of the 11 patients who underwent a second operation, 2 were subjected to digital subtraction angiography (DSA) and transcathete arterial embolization (TAE) to stop hemorrhage. Endoscopic hemostasis was performed to stop hemorrhage in 1 case. Conservative treatment was administered to stop hemorrhage in 1 case. The secondary surgery rate was 73.3%(11/15) with mortality and curative rates of 40%(6/15) and 60%(9/15), respectively. Conclusion:For delayed hemorrhage after D2 of gastric cancer, a second radical surgery and death rates were high. Therefore, patients suffering from hemorrhage should be subjected to comprehensive clinical treatment and positive measures. Major vascular bleeding, anastomotic leakage, anastomotic ulcer, and duodenal stump rupture are relevant risk factors. Anastomotic fistula and celiac artery bleeding complications caused hemorrhage is the leading cause of death. Extensive bleeding and unstable vital signs should be checked. A second operation and abdominal drainage should also be timely conducted to as effective methods. Realistic and conservative treatment can be administered to patients with stable vital signs and low amount of blood loss. Endoscopic hemostasis can be applied to alleviate simple anastomotic ulcer bleeding. DSA can be initially performed to detect unknown bleeding sites. TAE can be subsequently used to treat hemorrhage.