Objective:To identify the influencing factors for community elderly health services provided by general practitioners (GPs) using the social ecological theory, for reference in improving their participation and satisfaction.Methods:According to the social ecological theory, an ecological model for GPs to carry out community elderly health services was constructed from four levels: public policy ecology, community health service ecology, interpersonal relationship ecology, and individual characteristics ecology of general practitioners. A survey questionnaire was designed with six latent variables: public health policy support, public health service and basic medical service supply, doctor-patient relationship, individual participation and individual satisfaction. The questionnaire was distributed to 220 GPs from 11 primary healthcare institutions in Jiangsu province, China, who were randomly selected between October and November 2021. Exploratory and confirmatory analyses of the model were conducted using AMOS 25.0.Results:A total of 207 valid questionnaires were collected, and all the KMO values of the six latent variables were greater than 0.7, while the composite reliability values and average variance extracted values greater than 0.7 and 0.5, respectively. Both the reliability and validity of the data met the analysis requirements. Exploratory analysis revealed that public health policy support had a direct positive effect on both public health service and basic medical service supply (both effect sizes being 0.37). Public health service had a direct positive effect on doctor-patient relationship, individual participation and individual satisfaction (effect sizes being 0.52, 0.22, and 0.31, respectively). The direct effect of basic medical service supply on doctor-patient relationship was not significant (effect size being 0.03), but it had a direct positive effect on public health service (effect size being 0.46). Doctor-patient relationship had a direct positive effect on individual participation (effect size being 0.51), but its direct effect on individual satisfaction was not significant (effect size being 0.06). Individual participation had a direct positive effect on individual satisfaction (effect size being 0.52). Conclusions:By optimizing the public policy ecosystem, community health service ecosystem, and interpersonal relationship ecosystem, the participation and satisfaction of general practitioners can be systematically improved.

Objective:To investigate the incidence and treatment of gastric cancer in 16 medical centers in Tianjin from 2020 to 2021.Methods:The retrospective and descriptive study was conducted. The clinical data of 3 122 gastric cancer patients who underwent surgery in 16 medical centers, including Tianjin Medical University Cancer Institute & Hospital, et al, in Tianjin from 2020 to 2021 were collected. There were 2 112 males and 1 010 females, aged (64±11)years. Observation indicators: (1) general data of patients; (2) treatment situations; (3) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted by the chi-square test. Results:(1) General data of patients. From 2020 to 2021, a total of 3 122 gastric cancer patients received surgeries in 16 medical centers in Tianjin, including 2 112 males and 1 010 females. There were 1 443 cases in 2020, including 976 males and 467 females, aged (63±11) years. There were 1 679 cases in 2021, including 1 136 males and 543 females, aged (65±11) years. Of the 3 122 pati-ents, cases in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 696, 667, 1 466, 293, accounting for 22.293%(696/3 122), 21.365%(667/3 122), 46.957%(1 466/3 122), 9.385%(293/3 122), respectively. Cases with early gastric cancer, locally advanced gastric cancer, advanced gastric cancer account for 17.265%(539/3 122), 73.350%(2 290/3 122), 9.385%(293/3 122). There were 2 829 patients without distant metastasis and 293 patients with distant metastasis. For the 2 829 patients without distant metas-tasis, cases in stage T1, T2, T3, T4a, T4b accounted for 19.053%(539/2 829), 12.089%(342/2 829), 20.148%(570/2 829), 41.499%(1 174/2 829), 7.211%(204/2 829)respectively, cases in stage N0, N1, N2, N3 account for 37.328%(1 056/2 829), 16.331%(462/2 829), 15.836%(448/2 829), 30.505%(863/2 829). For the 293 advanced gastric cancer patients with distant metastasis, 190 cases had peri-toneal metastasis, 47 cases had lymph node metastasis, 27 cases had ovarian metastasis, 37 cases had liver metastasis, 14 cases had other metastasis (some patients had ≥2 distant metastases). (2) Treatment situations. ① For the 539 with early gastric cancer, cases undergoing endoscopic submu-cosal dissection, laparoscopic surgery, open surgery were 22, 150, 86 in 2020, versus 19, 212, 50 in 2021, showing a significant difference between them ( χ2=19.42, P<0.05). For the 498 patients with early gastric cancer who underwent laparoscopic or open surgery, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 25, 81, 30, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrec-tomy were 18, 309, 35, respectively, showing a significant difference between them ( χ2=40.62, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery and laparoscopic surgery were 446 and 617 in 2020, versus 410 and 817 in 2021, showing a significant difference between them ( χ2=17.75, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proxi-mal gastrectomy were 336, 377, 143, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 377, 920, 137, respectively, showing a significant difference between them ( χ2=89.64, P<0.05). Of the 293 patients with advanced gastric cancer, 175 cases underwent surgeries due to hemorrhage, stenosis, perforation, 76 cases under-went surgery after chemotherapy, 42 cases underwent surgery directly. ② For 756 cases of 3 122 pati-ents undergoing total gastrectomy, 357 and 4 cases received open digestive tract reconstruction including Roux-en-Y and other anastomosis, versus 380 and 15 cases with laparoscopic digestive tract reconstruction including Roux-en-Y and other anastomosis, showing a significant difference between them ( χ2=5.57, P<0.05). For 1 687 cases undergoing distal gastrectomy, 84, 160, 158, 55 cases received open digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, versus 154, 489, 417, 170 cases with laparoscopic digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, showing a significant difference between them ( χ2=10.90, P<0.05) . Of the 539 patients with early gastric cancer, 65 cases had lymph node metastasis, in which 18 of 306 stage T1a cases had lymph node metastasis and 47 of 233 stage T1b cases had lymph node metastasis. The number of detected lymph nodes for the 2 290 patients with advanced gastric cancer was 31±15, including ≥16 for 2 059 cases and ≥30 for 1 276 cases. Of the 3 122 patients, cases with neoadjuvant therapy, complete response and incomplete response was 128, 13 and 115 in 2020, versus 250, 49 and 201 in 2021, showing a significant difference between them ( χ2=5.51, P<0.05). (3) Postoperative complications. Of the 3 122 patients, 746 cases had postoperative complications, with an incidence of 23.895%(746/3 122). There were 62 patients with grade 3 or more complications. Reoperation was conducted in 34 patients. There were 14 cases of postoperative death. The duration of postoperative hospital stay and hospital expense were (11±5)days and (98 114±46 598)yuan for the 3 122 patients, (26±14)days and (122 066±68 317)yuan for cases with complications, (40±21)days and (196 926±12 747)yuan for cases with grade 3 or more complications. Conclusion:Compared with 2020, cases undergoing laparoscopic surgery and distal gastrectomy for gastric cancer in Tianjin increases in 2021, and the digestive tract reconstruction also differs. The number of patients with neoadjuvant chemotherapy and complete response rate for advanced gastric cancer increases.

Objective:To investigate the application value of magnetic resonance imaging (MRI) intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) metrics and texture analysis in the differential diagnosis and staging of nasopharyngeal carcinoma.Methods:The clinical data of 125 nasopharyngeal carcinoma patients (the research group) in Tangshan People's Hospital from October 2019 to October 2021 and 76 patients with nasopharyngeal hyperplasia during the same period (the control group) were retrospectively analyzed. All patients underwent MRI T2WI and IVIM-DWI sequence scanning, and then the plain T2WI images, DWI, and IVIM-DWI quantitative parameter pseudo-color maps including pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were obtained. The texture analysis metrics like apparent diffusion coefficient (ADC), D, D* and f were recorded. IVIM-DWI and texture analysis metrics were compared among patients in both groups and patients in different clinical stages; and the receiver operating characteristic (ROC) curve was plotted to evaluate the efficacy of IVIM sequence parameters and texture analysis metrics in the differential diagnosis and staging of nasopharyngeal carcinoma.Results:Compared with the control group, a marked reduction in D value [(0.80±0.13)×10 -3 mm 2/s vs. (1.19±0.27)×10 -3 mm 2/s], f value [(11.3±2.2)% vs. (15.6±3.3)%], mean ADC value [(0.92±0.17)×10 -3 mm 2/s vs. (1.16±0.19)×10 -3 mm 2/s] and variance (2 189±862 vs. 3 563±925) (all P < 0.05); a notable increase in skewness (0.50±0.17 vs. 0.31±0.12), kurtosis (0.56±0.13 vs. -0.21±0.06) and entropy (10.5±2.3 vs. 7.1±2.1) (all P < 0.05). The area under the curve (AUC) of IVIM sequence parameters and texture analysis metrics in the differential diagnosis of nasopharyngeal carcinoma was 0.763 and 0.803, respectively; the AUC, sensitivity and specificity of the combination of IVIM sequence parameters and texture analysis metrics for the differential diagnosis of nasopharyngeal carcinoma was 0.868, 89.6% and 86.8%, respectively. Compared with patients in stage Ⅰ-Ⅱ nasopharyngeal carcinoma, patients in stage Ⅲ-Ⅳ reported the lower D value [(0.75±0.13)×10 -3 mm 2/s vs. (0.89±0.16)×10 -3 mm 2/s], f value [(10.8±2.8)% vs. (12.1±3.0)%] (all P < 0.05), and the lower mean ADC value [(0.90±0.14)×10 -3 mm 2/s vs. (0.96±0.16)×10 -3 mm 2/s], and variance (2 063±831 vs. 2 431±846) (all P < 0.05), skewness (0.56±0.15 vs. 0.39±0.16), kurtosis (0.62±0.15 vs. 0.44±0.13) and entropy (11.0±2.1 vs. 9.1±2.4) (all P < 0.05). The AUC of IVIM sequence parameters and texture analysis metrics in differentiating nasopharyngeal carcinoma with different stages was 0.863 and 0.796, respectively; the AUC, sensitivity and specificity of the combination of IVIM sequence parameters and texture analysis metrics in differentiating nasopharyngeal carcinoma with different stages was 0.894, 85.4% and 90.7%, respectively. Conclusions:MRI texture analysis and IVIM quantitative analysis are of high value in the differential diagnosis and staging of nasopharyngeal carcinoma; and the texture analysis achieves higher sensitivity and specificity in the differential diagnosis and staging of nasopharyngeal carcinoma compared with IVIM quantitative analysis; the combined application of both has the highest overall efficacy.

This study was performed to determine the metabolic profile of four amide synthetic cannabinoids that recently abused, i.e., ADB-4en-PINACA, 4CN-CUMYL-BUTINACA, 5F-EMB-PICA and 4F-MDMB-BUTICA, in human liver microsomes (HLMs). The four amide synthetic cannabinoids were added to the microsomal incubation model, being incubated for 10 min, 60 min or 3 h to simulate human hepatic metabolism.Liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analytical instrument was employed to determine and speculate the structure of phase I metabolites and their possible metabolic pathways.The results showed that there were 27 phase I metabolic pathways for the four amide synthetic cannabinoids, including hydroxylation, carboxylation, N-dealkylation and ester hydrolysis, with the main phase I metabolic pathways of ester hydrolysis, dihydrodiol (pentenyl tail), oxidative defluorination to carboxylic acid, monohydroxylation (alkyl side chain or indole/indazole ring) and N-dealkylation.The results of this study may provide potential detection markers for forensic identification and sewage abuse assessment of the four amide synthetic cannabinoids.

Objective:To investigate the effect of Mediterranean diet on blood glucose control and cardiovascular risk factors in patients with type 2 diabetes.Methods:As to December 2021, the PubMed, Cochrance Central Register of Controlled Trials and Cochrance Database, Cochranc Library, Embase, China National Knowledge Infrastructure and Wanfang Medical Network system were searched for clinical randomized controlled trials(RCTs) of Mediterranean diet in patients with type 2 diabetes to conduct Meta-analysis The main observation index were cardiovascular risk factors, and the mean difference and its 95% confidence interval were used to estimate the effect size.Results:There were six RCTs, and 1181 patients met the inclusion criteria and entered the Meta-analysis. Compared with the control group, the intervention group can significantly reduce the level of systolic blood pressure ( MD=-1.20, 95% CI-2.21 to -0.19) and diastolic blood pressure ( MD=-4.17, 95% CI-7.12 to -1.22) in patients with type 2 diabetes mellitus, but there were no significant difference in the level of TC ( MD=2.92, 95% CI-0.84 to-6.67), HDL ( MD=2.33, 95% CI-0.27 to -4.92) and LDL ( MD=-2.34, 95% CI-5.67 to -0.99) between the two groups (all P>0.05). Conclusions:The meta-analysis provided evidence the Mediterranean diet showed the beneficial improvements in blood pressure glycemic control, but the effect of Mediterranean diet on lipid profile was not significant, which needed further verification.

Bioactive peptides play important roles in promoting human health, such as lowering blood pressure, blood sugar and blood lipid, anti-obesity, and anti-cancer. Thus, exploring functional bioactive peptides and developing efficient production technologies are of crucial importance. Herein, we review the development of function discovery and production technology for natural bioactive peptides. Presently, the top-down and bottom-up approaches are mainly used for the function discovery and production of natural active peptides. The top-down approach includes the direct extraction and identification for functional discovery, and the direct extraction, enzymatic hydrolysis and microbial fermentation for production. The bottom-up approach includes the polypeptide modification and database mining for functional discovery, and the chemical synthesis, enzyme synthesis, recombinant expression and cell-free synthesis for production. The top-down approach is usually associated with complicated process, lower efficiency, higher cost, harder quality control, and uncertain functionality, while the bottom-up approach is more suitable for the development of peptide drugs but difficult to be used for functional foods. With the technology development of sequencing and mass spectrometry, it is easier to obtain the proteomic information of various organisms at the molecular level. Based on the proteomic information, the top-down and bottom-up approaches can be combined to overcome the disadvantages of using these two approaches alone, thus providing a new strategy for the rapid development and production of natural active peptides.
Fermentation ; Humans ; Mass Spectrometry ; Peptides/metabolism* ; Proteomics ; Technology

In order to explore the treatment of Her-2 positive breast cancer patients who failed in multi-line treatments, we retrospectively analyzed the clinical data of a patient with refractory Her-2 positive breast cancer.The patient was initially diagnosed as Her-2 positive advanced breast cancer.After six line treatment in the outer hospital, the patient′s condition was basically in a progressive state.The breast tumor was broken and purulent, the lung metastasis increased, and the patient′s quality of life was poor.The patient was admitted to Department of Breast Surgery of Affiliated Suqian Hospital of Xuzhou Medical University, after MDT discussion, we gave pyrrolotinib combined with capecitabine treatment, the chest wound healed gradually, the lung metastasis gradually reduced, and the quality of life was better.A retrospective analysis of this case showed that pyrrolidine combined with capecitabine may bring hope to Her-2 positive breast cancer patients who failed to receive multi-line therapies, especially those who failed to target therapy.

Autophagy is one of the most common protective mechanisms during plant stress response. We studied the effect of exogenous Cd on autophagy in celery, by using transcriptome sequencing technique to analyze the differentially expressed genes under different Cd concentrations (0, 2, 4 and 8 mg/L). Eight differentially expressed autophagy-related genes were screened and identified by qRT-PCR. Cd had obvious toxic effect on celery, in a dose-dependent manner. Eight differentially expressed autophagy-related genes were screened, among which ATG8a, ATG8f, ATG13, AMPK-1 and AMPK-2 were up-regulated, whereas ATG12, VPS30 and VPS34 were first up-regulated and then decreased. The up-regulated expression of differential genes may resist Cd toxicity by increasing autophagosome structures; however, 8 mg/L Cd exceeded the autophagosome tolerance limit of celery, resulting in decreased expression of multiple autophagy-related genes. The above results can provide help for subsequent functional study of autophagy-related genes, and provide a reference for further exploring the tolerance mechanism of celery to Cd toxicity.

Objective To explore the efficacy of blood promoter methylation of Sox10 gene in diagnosis of intestinal neuronal dysplasia (IND) and to seek a non-invasive genetic diagnosis method based on peripheral blood for diagnosis of IND.Methods Children diagnosed as Hirschsprung disease (HD) or IND from the Shengjing Hospital of China Medical University and the Capital Institute of Pediatrics were enrolled in 2017-2018.The blood and colon specimens were collected from 9 IND,15 HD and 15 controls (the colon trauma cases).The blood promoter methylation of Soxl0 and its expression level in colon were both detected and the correlation between them was analyzed.The diagnostic efficacy of blood promoter methylation of Soxl0 was analyzed by receiver operating characteristics (ROC) curve.Results The blood promoter methylation level at the 32nd locus of Sox10 was 100％ (90％-100％;95％ CI:91％-98％) in the control,80％ (70％-90％;95％CI:65％-90％) in HD and 60％ (50％-80％;95％ CI:52％-82％) in IND.The expression level of Sox10 in the colon was (1.00 ±0.04) in the control,(2.75 ±0.16) in HD and (3.99 ±0.10) in IND.Western blot showed that the expression of Sox10 protein in the colon of the control group,the HD group and the IND group increased,and the difference was statistically significant (P ＜ 0.05).The blood promoter methylation level was negatively correlated with its expression level in colon (r =-0.88).ROC curve indicated area under curve (AUC) of Sox10 methylation in diagnosis of HD was 0.818,with a cut-off value of 85％ and low diagnostic sensitivity.The AUC in IND was 0.907,with a cut-off value of 85％,producing a sensitivity of 88.9％ and a specificity of 93.3％ respectively.Conclusion Blood promoter methylation of Sox10 might be used as a non-invasive method for diagnosis of IND.

Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.