Objective To investigate the potential of immune-inflammatory markers and the characteristics of magnetically controlled capsule endoscopy in distinguishing gastric adenocarcinoma from precancerous lesions,as well as to develop and validate a risk prediction model.Methods Retrospective analysis was conducted on medical records of 578 patients who underwent magnetic controlled capsule endoscopy at our hospital between January 2021 and December 2023.Following the principle of Pareto's law(80/20 rule),they were randomly divided into a training set(462 cases)and a validation set(116 cases).Magnetic controlled capsule endoscopy and blood cell tests were performed,with pathological diagnosis results serving as the"gold standard",to classify patients into groups of gastric adenocarcinoma and precancerous lesions.The magnetic controlled capsule endoscopic features,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)in patients with gastric adenocarcinoma and precancerous lesions were compared to develop and validate a risk diagnostic model for gastric adenocarcinoma.Results Among the 462 patients who underwent magnetic controlled capsule endoscopy,gastric adenocarcinoma was diagnosed in 76 cases through pathological examination,accounting for 16.45%(76/462),while precancerous lesions were observed in 386 cases,accounting for 83.55%(386/462).In the validation set of 116 patients who underwent gastric endoscopy,there were 22 cases of gastric adenocarcinoma,representing an incidence rate of 18.97%(22/116),and a total of 94 cases with precancerous lesions,accounting for an incidence rate of 81.03%(94/116).No statistically significant differences(P＞0.05)were found between the two groups regarding lesion size,border appearance,mucus presence or lesion morphology.However,compared to the precancerous lesion group,the proportion of whitish coloration as well as irregular surface microstructure and grid-like microvessels was significantly higher in the gastric adenocarcinoma group(P＜0.05).Moreover,both NLR and PLR values were significantly higher in the gastric adenocarcinoma group compared to those in the precancerous lesion group(P＜0.05).Irregular surface microstructure(OR=2.213,95%CI:1.288～3.801),irregular grid-like microvessels(OR=2.489,95%CI:1.458～4.249),NLR(OR=2.369,95%CI:1.389～4.046),and PLR(OR=3.016,95%CI:1.767～5.148)were identified as risk factors for gastric adenocarcinoma(P＜0.05).The sensitivity of the risk model for diagnosing gastric adenocarci-noma in the training set was 0.800(95%CI:0.716～0.891),with a specificity of 0.783(95%CI:0.694～0.851)and an area under the curve of 0.858(95%CI:0.787～0.931).In the validation set,the sensitivity for diagnosing gastric adenocarcinoma was 0.861(95%CI:0.771～0.945),with a specificity of 0.769(95%CI:0.683～0.841)and an area under the curve of 0.844(95%CI:0.765～0.923).Conclusion The surface microstructure,microvas-cular morphology,NLR,and PLR of gastric lesions are correlated with the occurrence of gastric adenocarcinoma.Developing a risk diagnostic model facilitates early identification and diagnosis of gastric adenocarcinoma.

Objective: To investigate the relationship between urinary monohydroxylated metabolites of hydroxyl polycyclic aromatic hydrocarbons (OH-PAHs) and lung function, as well as the role of oxidative stress in these associations, so as to provide a scientific basis for air pollution control and policy formulation. Methods: A panel study was carried out among 45 young healthy adults. Four follow up surveys and health examinations were conducted from November 2017 to October 2018 to measure lung function parameters [forced vital capacity (FVC), second forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), FEV1/FVC, and forced expiratory flow between 25% and 75% vital capacity (FEF 25%~75% )], markers of exposure to 7OHPAHs [∑ 7OH PAHs], and markers of oxidative stress[8 hydroxy 2 deoxyguanosine (8 OHdG) and 8 isoprostaglandin F 2α (8 iso PGF 2α )]. The relationship between urinary PAH metabolites and lung function was quantified by linear mixed effects models. Mediation analysis was performed to assess the role of oxidative stress in the relationship between OH PAHs and lung function. Results: The median values of FVC, FEV1, FEVI/FVC, PEF, and FEF 25%-75% were 4.37 L, 3.58 L, 83.00%, 4.38 L/s, and 3.32 L/s, respectively. The results showed that each 1 unit increase in log transformed value of 2 Hydroxyfluorene (2 OHFlu) was associated with a 5.05% decrease ( β %=-5.05%，95% CI =-8.85%--1.09%) in FVC, 4.15% decrease ( β %=-4.15%，95% CI =-7.94%- -0.22% ) in FEV1 and 5.87% decrease ( β %=-5.87%，95% CI =-11.35%--0.05%) in FEF 25%-75% , respectively. Each 1 unit increase in log transformed values of 2 OHFlu and 9 Phenanthrol (9 OHPhe) was associated with a 7.03% decrease ( β %=-7.03%，95% CI =-12.60%--1.11%) and a 7.08% decrease ( β%=-7.08%，95% CI =-13.50%--0.17%) in PEF, respectively. Additionally, urinary ∑ 7OH PAHs had a positive correlation with the levels of urinary 8 OHdG and 8 iso PGF 2α ( r =0.64, 0.69, P <0.01). Meanwhile, the levels of 8 OHdG mediated 17.06% and 15.71% of the association between 2 OHFlu with FVC and FEV1. Conclusion The finding reveales a negative relationship between urinary OH PAHs and lung function among young healthy adults. The 8 OHdG plays a mediated role in the correlation of 2 OHFlu with FVC and FEV1. Active relevant policies are needed to control air pollution and maintain the healthy living conditions of young people.

Objective:To observe the application effect of simulation medicine teaching in clinical practice teaching of respiratory department.Methods:A total of 96 five-year undergraduate students of clinical medicine specialty from Batch 2018 were randomized into in two groups in average. The traditional teaching group conducted bedside teaching according to traditional teaching outline, and the simulation medicine group used simulated medical teaching method. The performances of theoretical knowledge and skill operations and the teaching satisfaction with the department were evaluated between the two groups. SPSS 22.0 was used for t test and chi-square test. Results:There was no significant difference in theoretical knowledge between the two groups, but the results of skill operation test and satisfaction with the department of the simulation medicine group were significantly better than those of the traditional teaching group, and the difference was statistically significant [(80.92±5.99) vs. (87.71±4.95), P<0.050; χ2=26.14, P<0.05]. Conclusion:Simulation medicine teaching is better than traditional teaching in clinical practice teaching of respiratory department, which can improve students' clinical skills and operation level, cultivate good clinical thinking for students, and improve their learning interests.

Objective: To investigate the effects of maternal exposure to ambient fine particles (PM_2.5) in Fuzhou during pregnancy on immune responses to ovalbumin (OVA) in neonatal rats and the possible mechanisms. Methods: Pregnant Sprague-Dawley rats were randomly assigned into four groups (ten in each): filtered air (FA) plus normal saline (NS), airborne PM_2.5 plus NS (PM_2.5-NS), FA plus OVA (FA-OVA) and PM_2.5 plus OVA (PM_2.5-OVA) groups. Pregnant dams in the PM_2.5 exposure groups were placed in a PM_2.5 exposure chamber in which the PM_2.5 concentration was equal to the ambient air from the beginning of gestation till delivery, whereas the other dams inhaling air without particulate matters were put into a clean chamber. OVA sensitization was conducted through intraperitoneal injection of OVA at 50 μg per dam at 4 and 9 days of gestation, followed by inhalation of atomized 1% OVA for 30 min at 18, 19 and 20 days of gestation. Dams without OVA sensitization were given NS in the same way. Levels of interleukin (IL)-4, IL-5 and interferon-γ (IFN-γ) in neonatal rats' plasma were measured by enzyme-linked immunosorbent assay just after birth. Protein levels of transcription factors GATA-3 and T-bet in lung were analyzed by Western-blotting. Changes in microRNA(miR)-146a and miR-146b in spleen were detected by real-time polymerase chain reaction. Histological changes in lung were observed under light microscope. One-way analysis of variance and LSD test were used as statistical methods. Results: (1) IL-4 level in plasma was significantly increased in PM_2.5-NS [(18.56±7.04) ng/L], FA-OVA [(34.04±7.06) ng/L] and PM_2.5-OVA groups [(45.67±8.18) ng/L] as compared with that in FA-NS group [(10.51±2.88) ng/L], and the level of IL-4 in PM_2.5-OVA group was higher than that in PM_2.5-NS and FA-OVA groups (F=54.667, P<0.001). Significantly increased IL-5 level in plasma was found in FA-OVA and PM_2.5-OVA groups as compared with that in FA-NS group (F=6.253, P=0.023). Among the four groups, FA-OVA group showed significantly increased IFN-γ level in plasma (F=28.604, P<0.001). (2) GATA-3 level in lung tissues was significantly increased in PM_2.5-NS (31.09±3.54), FA-OVA (35.24±5.00) and PM_2.5-OVA groups (47.81±3.63) as compared with that in FA-NS group (24.19±3.12), and higher in PM_2.5-OVA group than in PM_2.5-NS and FA-OVA groups (F=96.581, P<0.001). T-bet level was significantly lower in FA-OVA and PM_2.5-OVA groups than in FA-NS group. Moreover, PM_2.5-OVA group showed decreased T-bet level as compared with that in PM_2.5-NS and FA-OVA groups (F=30.852, P<0.001). (3) Expression of miR-146a in spleen was significantly enhanced in PM_2.5-NS (1.72±0.27), FA-OVA (1.56±0.37) and PM_2.5-OVA groups (3.06±0.52) than in FA-NS group (1.05±0.25). Moreover, PM_2.5-OVA group showed enhanced expression of miR-146a as compared with that in PM_2.5-NS and FA-OVA groups (F=42.276, P<0.001). Changes in the expressions of miR-146b were similar to those in miR-146a (F=28.776, P<0.001). (4) Stenosis or disappearance of alveolar spaces, accompanied with infiltration of inflammatory cells in interstitial substance and congestion in alveolar septum, was seen in FA-OVA and PM_2.5-OVA groups and conditions in the latter group were more severe. Conclusions Intrauterine exposure to ambient PM_2.5 negatively affects fetal lung development and immunological function in rats, especially when the dams are sensitized with OVA during pregnancy.

Objective To discuss our drug clinical trial institution's experience and findings during the process of establishing drug clinical trial central pharmacy.Methods Analyze the previous key issues identified during the drug management under different modes,discuss the necessity and feasibility of establishing drug clinical trial central pharmacy.Meanwhile,discuss the planning and construction of hardware including location site of the central pharmacy,equipment and facilities,staff,as well as software such as electronic management system and standard operation procedures.Results After the adoption of central trial pharmacy,space and energy are saved,manpower and material resources are saved,the quality of clinical trials also improved.Conclusions Standardized and unified management of investigational drugs through establishing drug clinical trial central pharmacy,is the strong guarantee for the drug safety of human subject,as well as the accuracy and scientificity of trial results.

Objective: To investigate the effect of overexpression of wild-type phosphatase and tensin homolog (PTEN) deleted on chromosome 10 and its mutant G129E (exhibiting the activity of protein phosphatase and losing the activity of lipid phosphatase) on F-actin in activated hepatic stellate cells (HSCs) cultured in vitro. Methods: The activated hepatic stellate cell-T6 (HSC-T6) cells were cultured in vitro, and activated HSCs were transfected with adenovirus that carried wild-type PTEN gene and G129E gene using transient transfection. The HSCs were divided into the following groups: control group, which was transfected with DMEM medium instead of virus solution; Ad-GFP group, which was transfected with the empty adenovirus vector with the expression of green fluorescent protein (GFP); Ad-PTEN group, which was transfected with the recombinant adenovirus with wild-type PTEN gene and GFP expression; Ad-G129E group, which was transfected with the recombinant adenovirus with G129E gene and GFP expression. Western blot and quantitative real-time PCR were used to measure the protein and mRNA expression of PTEN in activated HSCs; under a laser scanning confocal microscope (LSCM), phalloidine labeled with the fluorescein tetramethylrhodamine isothiocyanate (TRITC) was used to observe the morphology of HSCs, distribution and fluorescence intensity of F-actin, and changes in pseudopodia and stress fibers, and a calcium fluorescence probe (Rhod-2/AM) was used to measure the changes in Ca²⁺ concentration in HSCs. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference test was used for comparison between two groups. Results: Wild-type PTEN and G129E genes were highly expressed in activated HSCs. In the control group and the Ad-GFP group, HSCs had a starlike or polygonal shape, F-actin was reconfigured and formed a large number of stress fibers which stretched across the whole cell, and layered pseudopodia were seen around the cell. In the Ad-PTEN group and the Ad-G129E group, the HSCs had a fusiform shape, F-actin was mainly seen around the cell, a small number of stress fibers were seen inside the cell, and layered pseudopodia around the cell disappeared. The Ad-PTEN group and the Ad-G129E group had significant reductions in the fluorescence intensity of F-actin compared with the control group and the Ad-GFP group (357.67±13.39/377.25±14.55 vs 961.87±27.33/954.68±20.71, F = 1783.486, P < 0.05), while there were no significant differences between the Ad-PTEN group and the Ad-G129E group, as well as between the control group and the Ad-GFP group (P > 0.05). The Ad-PTEN group and the Ad-G129E group had significant reductions in the relative concentration of Ca²⁺ compared with the control group and the Ad-GFP group (251.60±90.88/352.18±146.01 vs 1953.95±132.99/1937.57±115.17, F = 834.988, P < 0.05), while there were no significant differences between the Ad-PTEN group and the Ad-G129E group, as well as between the control group and the Ad-GFP group (P > 0.05). Conclusion The overexpressed wild-type PTEN and its mutant G129E can significantly inhibit the formation and reconfiguration of cytoskeletal protein F-actin and reduce the concentration of Ca2+ in activated HSCs in vitro. In addition, there are no significant differences in the above effects between wild-type PTEN and G129E.

Objective To describe the general characteristics of patients with acute chest pain in order to analyze factors associated with patients’utilization of emergency medical services (EMS).Methods A total of 747 eligible patients with acute chest pain admitted to emergency department of Qilu Hospital were consecutively enrolled from October 2014 to April 2015.Clinical data including demographic features, mode of arrival,past medical history,risk factors,symptoms and signs were collected prospectively by using standardized case report form.Univariate and multivariate analyses were carried out to investigate the association between the decision to use EMS and related factors including demographic features,past medical history,risk factors,symptoms and signs.Results Of the total 747 eligible patients,414 (55.4%)were male ,and the mean age was (57.2 ± 15.8)year;333 (44.6%)were female,and the mean age was (61.7 ±14.9)year.Of them,171 (22.9%)patients used EMS,and 143 chest pain patients with more than 75 years old were more inclined to use EMS (P <0.01),whereas 152 patients in 65 -75 years age group accounted for the lowest proportion of using EMS.Men were more inclined to use EMS than women (P <0.05),and 483 patients with typical chest pain used more EMS than patients with atypical chest pain (P <0.05);Of them,356 patients with a history of hypertension and 54 patients with a history of cerebral infarction were more inclined to use EMS (P <0.05 and P <0.01,respectively).Multivariate logistic regression analysis showed that male,older than 75 years,history of cerebral infarction were independent factors associated with EMS use (P <0.05).Conclusions This study indicated that only less than one-third of emergency department visits with acute chest pain decide to use EMS when symptoms occurred. Factors including male,older than 75 years,and a history of cerebral infarction were associated with more use of EMS.In order to promote patient asking for EMS timely,more work should be done.

Objective To improve the quality of medical device clinical trial.Methods To analyze medical device clinical trials conducted in our hospital from 2006 to 2010,and proposed the strategy to strengthen medical device clinical trial management.Results Most of the medical devices clinical trials were class Ⅲ medical devices clinical validation in our hospital,Surgical departments undertook most of the clinical trials.Until July 2013,49 trials were done only 56％ of undertake the project.96％ of completed trials were approved for medical device registration certificate.Conclusions The quality of clinical trials must be improved,andthe quality control process in medical device clinical trial should be reinforced.

Objective To investigate the relationship between serum levels of surfactant protein( SP)-A,SP-C and lung function impairment in coal workers with pneumoconiosis(CWP) in order to provide evidence for the biomarker study of pneumoconiosis.Methods Thirty-two coal workers with pneumoconiosis snd 41 healthy controls were included in this study.Serum levels of SP-A and SP-C were measured.Grading assessment of dyspnea and pulmonary function including predicted percentages of FVC,FEV1,FEV/FVC,MVV,and DLCO were conducted.Results Among the 32 participants with CWP,the severity of dyspnea was rated as level Ⅲ for 14 and level Ⅳ for 18 individuals.The pulmonary function was significantly impaired in CWP patients with level Ⅳ dyspnea compared with the healthy controls (FEV1％ predicted:[69.38 ± 15.17 ]％ vs.[96.35 ±10.24 ] ％ ; MVV％ predicted:[ 65.89± 8.14 ] ％ vs.[ 94.13 ± 10.38 ] ％ ; DLCO％ predicted:[ 96.51 ±11.37 ] ％.The serum levels of SP-A and SP-C were significantly higher in CWP patients than that in the healthy controls (SP-A:[4.02 ± 1.22] μg/L vs.[2.41 ±0.68 ] μg/L,t =6.480,P =0.001 ;SP-C:[3.58 ±0.67 ] ng/L vs.[ 2.31 ± 0.29] ng/L,t =9.290,P ＜ 0.001 ).Serum SP-A and SP-C levels in CWP patients were found to be significantly correlated with exposure to dust,dyspnea severity,FEV1％ predicted and DLCO％ predicted.Conclusion Serum SP-A and SP-C levels in CWP patients are closely associated with lung function,suggesting their role as candidate biomarkers for CWP.