Precancerous lesions of gastric cancer is a key stage in the development of gastric cancer.The reprogramming of glucose metabolism is a prominent feature of precancerous lesions of gastric cancer.Hypoxic microenvironment and hypoxia-inducible factors are important factors influencing the occurrence of glucose metabolic reprogramming.This article summarized the relationship between hypoxic microenvironment and the reprogramming of glucose metabolism in precancerous lesions of gastric cancer,and concluded the relevant research on TCM compounds and effective components to improve hypoxic microenvironment and further regulate glycolysis for the treatment of this disease.It was concluded that the mechanism may be the inhibition of angiogenesis,regulation of signaling pathways and key proteins of glycolysis,expression of multiple enzymes,reduction of lactate secretion,inhibition of cell malignant proliferation and invasion.It explored the mechanism of Chinese materia medica in improving hypoxic microenvironment and regulating glycolysis,so as to provide reference for the prevention and treatment of precancerous lesions of gastric cancer.

Background and Objectives: The search for a suitable alternative for urethral defect is a challenge in the field of urethral tissue engineering. Induced pluripotent stem cells (iPSCs) possess multipotential for differentiation. The in vitro derivation of urothelial cells from mouse-iPSCs (miPSCs) has thus far not been reported. The purpose of this study was to establish an efficient and robust differentiation protocol for the differentiation of miPSCs into urothelial cells. Methods: and Results: Our protocol made the visualization of differentiation processes of a 2-step approach possible. We firstly induced miPSCs into posterior definitive endoderm (DE) with glycogen synthase kinase-3β (GSK3β) inhibitor and Activin A. We investigated the optimal conditions for DE differentiation with GSK3β inhibitor treatment by varying the treatment time and concentration. Differentiation into urothelial cells, was directed with all-trans retinoic acid (ATRA) and recombinant mouse fibroblast growth factor-10 (FGF-10). Specific markers expressed at each stage of differentiation were validated by flow cytometry, quantitative real-time polymerase chain reaction (qRT-PCR) assay, immunofluorescence staining, and western blotting Assay. The miPSC-derived urothelial cells were successfully in expressed urothelial cell marker genes, proteins, and normal microscopic architecture. Conclusions We built a model of directed differentiation of miPSCs into urothelial cells, which may provide the evi-dence for a regenerative potential of miPSCs in preclinical animal studies.

Objective:To analyze the usage intention and key issues of medical staff to use telemedicine, for improving telemedicine service system in China.Methods:From October to November 2019, medical workers of both the inviting party and invited party who experienced telemedicine in seven provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai were selected for an online questionnaire survey. Areas covered included their usage intention, satisfaction and cognitive appraisal of telemedicine. Descriptive statistical analysis and non-parametric test were used to discuss the intention of further use, satisfaction and challenges of medical workers in various provinces and regions.Results:1 084 valid questionnaires were recovered. The data found the overall satisfaction was 98.62%, and the proportion of their intention of further use was 98.25%, and those from the eastern and western provinces presented higher intention of usage. The top challenges as reflected by these medical workers were named as follows: timeliness of consultation progress and information feedback; long latency time; low Internet speed, poor and interrupted Internet signal; inadequate system equipments and inconvenient operation; difficulties in remote physical checkup and overall understanding of patient conditions; as well as substandard, incomplete and poor medical records.Conclusions:These medical workers are satisfied with the telemedicine services and willing to continue to use telemedicine.For those existing problems, it is suggested to strengthen the infrastructure and optimize the process of telemedicine services, so as to encourage them in greater use of telemedicine.

Objective:To analyze the actual and expected incentives and key issues of telemedicine providers in China and to provide important references for optimizing telemedicine incentive policies.Methods:The sample data came from a questionnaire survey of 1 084 providers in 7 provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai in October and November 2019 and a semi-structured interview data at 6 hospitals in Henan province in January 2020. Descriptive analysis was used to sort such data into text data for classified summation.Results:The greatest gaps were found between actual incentives and expected ones in expense subsidies, title promotion and excellence awards, with such gaps as high as 18.65, 28.26, 29.28 percentages among providers of junior, deputy senior and senior academic titles respectively. Hospitals fall short in providing adequate incentives for telemedicine providers, not to mention lack of differentiation and diversification in personnel incentives, and poor implementation of incentive policies.Conclusions:It is suggested to strengthen incentive demand analysis, break the homogenization bottleneck of incentive policies, and consolidate internal publicity and implementation of incentive policies.

Objective: To investigate the influencing factors of the implementation of precision medical services based on clinician cognition, and provide a scientific reference for the implementation and advancement of precision medical services. Methods: Using electronic questionnaires, clinicians from 48 hospitals in 12 provinces(autonomous regions and municipalities directly under the Central Government) were surveyed from July to September 2019, with 341 valid questionnaires collected. Descriptive statistics and factor analysis were performed on the survey data. Results: Three dimensions that affect precision medical services were identified from the recovered questionnaires, namely external support factors, hospital drive capabilities, patient information provision and protection. The contribution rate of variance after orthogonal rotation was 35.157%, 22.234% and 16.343% respectively. Conclusions The external supporting factors should be developed, the hospital driving ability should be strengthened, and the patient information reception and privacy information security should be ensured to provide an important basis and guarantee for the implementation of precision medical service.

Objective To investigate the occurrence of deep venous thrombosis (DVT) in the perioperative period of patients with fracture distal to the knee,so that clinicians have a better understanding of the occurrence of DVT in the perioperative period of the fracture distal to the knee.Methods A retrospective analysis of the clinical data of 365 patients with distal knee fractures who underwent surgery in the Department of Orthopaedics Trauma,Xi'an Jiaotong University Medical College Red Cross Hospital from June 2014 to March 2018 was conducted.There were 213 males and 152 females,aged (45.05 ± 15.24) years,with an age range of 17-83 years.Classification of fracture sites:177 cases of tibiofibular shaft fracture,130 cases of ankle fracture,and 58 cases of foot fracture.According to whether thrombosis occurred or not,the patients were divided into thrombotic group and non-thrombotic group before and after operation.There were 66 patients with thrombosis before operation,299 patients without thrombosis before operation,88 patients with thrombosis after operation,and 277 patients without thrombosis after operation.The incidence of thrombosis and the location of the thrombus were recorded.The sex,age,fracture site,ASA score,operation time,the time from injury to admission,the time from injury to surgery,intraoperative tourniquet time,intraoperative blood transfusion volume,intraoperative blood loss,intraoperative transfusion volume,hemoglobin volume at admission and 1 day after operation,D-dimer level at admission and 1 day after operation,multiple injuries,chronic hepatitis and medical diseases were analyzed.The measuremernt data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),the t test was used for comparison between two groups.The comparison of count data was performed by x2 test or Fisher exact probability method,and multivariate logistic regression analysis was performed on the risk factors affecting the occurrence of DVT in both lower extremities.Results The preoperative DVT rate was 18.1％ (66/365).In patients with thrombosis,distal thrombosis accounted for 93.94％ (62/66),and mixed thrombosis accounted for 6.06％ (4/66).The incidence of postoperative DVT was 24.1％ (88/365).In patients with thrombosis,distal thrombosis accounted for 94.32％ (83/88),proximal thrombosis accounted for 1.14％ (1/88),and mixed thrombus accounted for 4.55％ (4/88).Fracture site,ASA score,operation time,intraoperative tourniquet time,intraoperative blood transfusion volume,intraoperative blood loss,intraoperative transfusion volume were not statistically significant(P ＞0.05).Age ≥ 40 years (OR =2.691,95％ CI:1.422-5.093,P =0.002),the time from injury to admission ＞ 3 days (OR =1.927,95 ％ CI:1.072-3.463,P =0.028)were independent risk factors for DVT formation in fracture distal to the knee before operation.Age ≥ 40 years (OR =3.925,95 ％ CI:2.161-7.129,P =0.000),the time from injury to surgery ＞ 5 days (OR =1.835,95 ％ CI:1.080-3.119,P =0.025),D-dimer level at 1 day after operation (OR =1.191,95％ CI:1.096-1.293,P =0.000),combined with multiple injuries (OR =1.981,95％ CI:1.006-3.902,P =0.048),combined with coronary atherosclerotic heart disease (OR =2.692,95％ CI:1.112-6.517,P =0.028) were independent risk factor for DVT formation after operation for fracture distal to the knee.Conclusions The occurrence of DVT before and after the fracture of the knee is mainly caused by distal thrombosis,and proximal thrombosis also occurs.Those patients aged≥40 years,combined with multiple injuries and coronary heart disease,should focus on preventing the occurrence of DVT.After the injury,the patient is immediately admitted to the hospital for DVT screening,and when the general condition allowed,shortening the preoperative waiting time can reduce the occurrence of DVT.

Telemedicine can optimize deployment of medical resources and minimize diagnosis discrepancies.Formulation of a rational project pricing and scientific compensation policy will be conducive to its future development. The concept of human resource consumption in RBRVS was used as reference to improve the activity-based costing ( ABC ) method. The authors sorted out the resource cost repository, identified the activity system, classified the motivation resources into respective activity cost repositories, and calculated the cost of respective cost object distribution.The cost of three telemedicine service items(remote single discipline consultation, remote image consultation and remote pathology consultation were 119.69, 147.03 and 161.61 yuan respectively) was calculated by the improved ABC.It can better indicate project costs than that calculated by the traditional ABC(137.30, 147.17 and 144.08 yuan), and proves more consistent with the existing prices of other province(134.00, 150.00 and 174.00 yuan).

OBJECTIVE： To study the mechanism of wound healing promotion of Panax notoginseng-Bletilla striata gum sponge on diabetic foot ulcer （DFU） model rats. METHODS： Healthy SD rats were selected and given high-lipid and high-glucose diet， intraperitoneal injection of streptozotocin once to establish diabetes model. Neodymium-iron-boron magnet was used to press the back of rats to make ulcer wound then established DFU model. Totally 60 DFU model rats were randomly divided into group A（blank group， i.e. normal saline gauze group）， group B（vaseline gauze group），group C （gelatin sponge group） and group D （P. notoginseng-B. striata gum sponge group）， with 15 rats in each group. The rats were given corresponding gauze/sponge to cover the wound for intervention treatment， changing dressing once every 1-2 days. On the 3rd and 7th day after intervention， the wound healing of rats in each group was observed with naked eyes， and the wound healing rate was calculated. The wound margin tissue was collected to obtain HE staining section， and histopathological observation was conducted under microscope. mRNA expression of β-catenin， GSK-3β and Rspo3 in wound tissue were determined by RT-PCR. RESULTS： On the 3rd and 7th day after intervention， compared with group A， B， C， healing rate of group D was increased significantly （P＜0.05）； inflammatory cell infiltration， collagen deposition， capillary and granulation tissue growth in wound tissue increased significantly. The mRNA expression levels of β-catenin and Rspo3 all increased， and those of GSK-3β all decreased； except for the difference of β-catenin at the 3rd day and GSK-3β at the 7th day after intervention between group D and group C were not significant， the difference of other indicators was statistically significant （P＜0.05）. CONCLUSIONS： P. notoginseng-B. striata gum sponge can effectively promote the wound healing in DFU model rats， the mechanism of which may be associated with up-regulating the expression of β-catenin and Rspo3 mRNA and down-regulating the expression of GSK-3β mRNA.

Objective To study the value of platelet/lymphocyte ratio(PLR)in predicting coronary artery lesions and their outcome in acute coronary syndrome(ACS)patients after PCI.Methods Three hundred and forty-four elderly ACS patients who underwent PCI and CAG in our hospital from May 2016to August 2018were divided into MACCE group(n=95)and MACCE-free group (n=249).They were further divided into high PLR group(n=247)and low PLR group(n=97) according to the ROC curve for PLR.Their clinical data were analyzed,and the prognostic threshold of PLR was determined according to the ROC curve for PLR and logistic regression analysis respectively.Results The number of smokers was significantly greater,the incidence of DM,serum LDL-C level,PLR and Gensini score were significantly higher in MACCE group than in MACCE-free group(P＜0.01).The area under the ROC curve for PLR in predicting the poor outcome in ACS patients after PCI was 0.898and 0.842respectively(95％CI:0.859-0.937,95％CI:0.794-0.891).The PLR was positively related with the Gensini score(r=0.654,P＜0.01).The incidence of MACCE was significantly higher in high PLR group than in low PLR group(78.35％ vs 7.69％,P＜0.01).High PLR was an independent risk factor for MACCE in elderly ACS patients after PCI(OR=2.527,95％CI:1.058-6.039,P=0.037).Conclusion PLR is related with MACCE in elderly ACS patients after PCI.

Objective Perioperative myocardial infarction remains a severe complication in non-cardiac surgery and is one of the major causes of death.Cardiac troponin (cTn) Ⅰ elevation is associated with short-term and long-term mortality.The aim of the study was to assess the proportion rate of cTnⅠ elevation and its clinical characteristics among patients admitted for orthopaedic surgery with or without cardiovascular events.Methods This is a retrospective study including 27 744 patients aged 50 years or older who admitted for orthopaedic surgery from 2009-2015 in Beijing Jishuitan Hospital.Results Two hundred and sixty-five patients [age (71.7±9.9) years] had cTnⅠ level＞ 0.04 μg/L with 66％ (175 patients) of them being female.Among them,59 patients were isolated troponin rise (ITR) (n=59),13 were preoperative acute myocardial infarction (AMI),and 193 were postoperative AMI.The proportion of postoperative AMI was 0.69％.Those patients were more likely to have a history of coronary artery disease or hypertension.Non-ST-segment elevation myocardial infarction (NSTEMI) was more common (93.3％) than ST-segment elevation myocardial infarction in these patients.Most of them did not experience ischemic symptoms.Totally 76.7％ of the AMI occurred within 3 days of surgery;and the in-hospital mortality rate was 10.4％.Conclusions Perioperative elevation of troponin is common in patients undergoing orthopaedic surgery.Most postoperative AMI were NSTEMI and with absent or atypical ischemia symptoms.Monitoring troponin levels and electrocardiograph in at-risk patients is needed to find most of the AMI.