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Background/Aims@#Gastric intestinal metaplasia (GIM), a common precancerous lesion of gastric cancer, can be caused by bile acid reflux. GATA binding protein 4 (GATA4) is an intestinal transcription factor involved in the progression of gastric cancer. However, the expression and regulation of GATA4 in GIM has not been clarified. @*Methods@#The expression of GATA4 in bile acid-induced cell models and human specimens was examined. The transcriptional regulation of GATA4 was investigated by chromatin immunoprecipitation and luciferase reporter gene analysis. An animal model of duodenogastric reflux was used to confirm the regulation of GATA4 and its target genes by bile acids. @*Results@#GATA4 expression was elevated in bile acid-induced GIM and human specimens.GATA4 bound to the promoter of mucin 2 (MUC2) and stimulate its transcription. GATA4 and MUC2 expression was positively correlated in GIM tissues. Nuclear transcription factor-κB activation was required for the upregulation of GATA4 and MUC2 in bile acid-induced GIM cell models. GATA4 and caudal-related homeobox 2 (CDX2) reciprocally transactivated each other to drive the transcription of MUC2. In chenodeoxycholic acid-treated mice, MUC2, CDX2, GATA4, p50, and p65 expression levels were increased in the gastric mucosa. @*Conclusions@#GATA4 is upregulated and can form a positive feedback loop with CDX2 to transactivate MUC2 in GIM. NF-κB signaling is involved in the upregulation of GATA4 by chenodeoxycholic acid.

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Background/Aims@#Cancer stem cells (CSCs) are believed to drive tumor development and metastasis. Activin and hepatocyte growth factor (HGF) are important cytokines with the ability to induce cancer stemness. However, the effect of activin and HGF combination treatment on CSCs is still unclear. @*Methods@#In this study, we sequentially treated colorectal cancer cells with activin and HGF and examined CSC marker expression, self-renewal, tumorigenesis, and metastasis. The roles of forkhead box M1 (FOXM1) and sex-determining region Y-box 2 (SOX2), two stemness-related transcription factors, in activin/HGF-induced aggressive phenotype were explored. @*Results@#Activin and HGF treatment increased the expression of CSC markers and enhanced sphere formation in colorectal cancer cells. The tumorigenic and metastatic capacities of colorectal cancer cells were enhanced upon activin and HGF treatment. Activin and HGF treatment preferentially promoted stemness and metastasis of CD133 + subpopulations sorted from colorectal cancer cells. FOXM1 was upregulated by activin and HGF treatment, and the knockdown of FOXM1 blocked activin/HGF-induced stemness, tumorigenesis, and metastasis of colorectal cancer cells.Similarly, SOX2 was silencing impaired sphere formation of activin/HGF-treated colorectal cancers. Overexpression of SOX2 rescued the stem cell-like phenotype in FOXM1-depleted colorectal cancer cells with activin and HGF treatment. Additionally, the inhibition of FOXM1 via thiostrepton suppressed activin/HGF-induced stemness, tumorigenesis and metastasis. @*Conclusions@#Sequential treatment with activin and HGF promotes colorectal cancer stemness and metastasis through activation of the FOXM1/SOX2 signaling. FOXM1 could be a potential target for the treatment of colorectal cancer metastasis.

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【Objective】 To investigate the predictive value of preoperative platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) (NLR-PLR) in peripheral blood for the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical surgery. 【Methods】 The clinical data of 104 UTUC patients who underwent radical nephroureterectomy plus bladder sleeve resection in our hospital during Jan.2015 and Dec.2020 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was drawn according to NLR and PLR, the optimal cut-off values of NLR and PLR were calculated, and NLR-PLR was determined accordingly. The patients were divided into NLR-PLR group 1 (PLR ≥161.46 and NLR≥ 2.51) and NLR-PLR group 0 (remaining patients). Chi-square test was used for comparison between groups, and the Kaplan-Meier method was used to draw survival curves. According to the Cox univariate and multivariate risk regression models, the risk factors for decreased overall survival (OS) were determined. 【Results】 The optimal cut-off values of PLR and NLR were 161.46 and 2.51, respectively. There were 74 patients in the NLR-PLR group 0 and 30 in the NLR-PLR group 1. Cox multivariate regression analysis showed that T stage, maximum tumor diameter and NLR-PLR were independent risk factors for reduced OS (P<0.05). 【Conclusion】 Preoperative NLR-PLR is a potential predictor of the prognosis of UTUC patients. Higher NLR-PLR is associated with poorer prognosis.

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In order to improve the disaster response ability of resident physicians under standardized training, this study designed a disaster medicine curriculum of traditional Chinese and Western medicine with reference to domestic and foreign experience. The curriculum consisted of 8 modules with a total of 26 class hours. The definition and classification of disasters and the status of traditional Chinese medicine in disaster medicine were introduced. This study evaluated the teaching effect of disaster medicine curriculum of traditional Chinese and Western medicine carried out by the Emergency Trauma Center of the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in 84 resident physicians under standardized training. The results showed that the objective test scores of resident physicians under standardized training before and after the course were (45.00±2.51) and (76.25±2.76), respectively ( P<0.001). A questionnaire survey on the subjective understanding of knowledge related to disaster medicine of traditional Chinese and Western medicine was conducted among resident physicians under standardized training before and after the course. The results showed that the test scores before and after the course were (50.88±1.41) and (64.64±1.80), respectively ( P<0.001). This study showed that the theoretical knowledge, skills, and comprehensive ability of resident physicians under standardized training in disaster relief have been greatly improved through the disaster medicine-related curriculum, providing a reference for the establishment of disaster medical education-related curriculum of integrated traditional Chinese and Western medicine.

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Beginning in late 2020, the emergence and spread of multiple variant SARS-CoV-2 strains harboring mutations which may enable immune escape necessitates the rapid evaluation of second generation COVID-19 vaccines, with the goal of inducing optimized immune responses that are broadly protective. Here we demonstrate in a mouse immunogenicity study that two doses of a modified B.1.351 spike (S)-Trimer vaccine (B.1.351 S-Trimer) candidate can induce strong humoral immune responses that can broadly neutralize both the original SARS-CoV-2 strain (Wuhan-Hu-1) and Variants of Concern (VOCs), including the UK variant (B.1.1.7), South African variant (B.1.351) and Brazil variant (P.1). Furthermore, while immunization with two doses (prime-boost) of Prototype S-Trimer vaccine (based on the original SARS-CoV-2 strain) induced lower levels of cross-reactive neutralization against the B.1.351 variant, a third dose (booster) administered with either Prototype S-Trimer or B.1.351 S-Trimer was able to increase neutralizing antibody titers against B.1.351 to levels comparable to neutralizing antibody titers against the original strain elicited by two doses of Prototype S-Trimer.

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Objective:To investigate the value of peripheral blood eosinophils (EOS) in predicting the therapeutic effect of sublingual specific immunotherapy (SLIT) in patients with allergic rhinitis (AR).Methods:From January 2018 to June 2020, 200 patients with AR who received SLIT in Dongguan Kanghua Hospital were evaluated for their symptoms before treatment and 6 months after treatment. The curative effect was evaluated according to the improvement of the total symptom score. The number of eosinophils, percentage of eosinophils in peripheral blood were measured before treatment. The correlation between curative effect and EOS count and EOS percentage was analyzed and the value of these two indicators in predicting the efficacy of SLIT was evaluated.Results:Of the 200 AR patients, 178 patients were confirmed to have completed the treatment course of 6months. 126 effective and 52 ineffective, the effective rates were 70.8%. There was a weak correlation between the number of EOS in peripheral blood and the percentage of EOS in peripheral blood before treatment and the efficacy of SLIT ( r=0.168, P=0.048; r=0.250, P=0.001). The area under the curve of peripheral blood EOS count was 0.380, and the percentage of peripheral blood EOS was 0.355, which were all less than 0.5. Conclusions:There was no significant correlation between the number of peripheral blood EOS count and peripheral blood EOS percentage and the efficacy of SLIT , therefore, both of blood EOS count and blood EOS percentage have no value in predicting the efficacy of SLIT.

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SARS-CoV-2 is the underlying cause for the COVID-19 pandemic. Like most enveloped RNA viruses, SARS-CoV-2 uses a homotrimeric surface antigen to gain entry into host cells. Here we describe S-Trimer, a native-like trimeric subunit vaccine candidate for COVID-19 based on Trimer-Tag technology. Immunization of S-Trimer with either AS03 (oil-in-water emulsion) or CpG 1018 (TLR9 agonist) plus alum adjuvants induced high-levels of neutralizing antibodies and Th1-biased cellular immune responses in animal models. Moreover, rhesus macaques immunized with adjuvanted S-Trimer were protected from SARS-CoV-2 challenge compared to vehicle controls, based on clinical observations and reduction of viral loads in lungs. Trimer-Tag may be an important new platform technology for scalable production and rapid development of safe and effective subunit vaccines against current and future emerging RNA viruses.

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Objective To understand the filialpiety values, anxiety and caregiving burden of caregivers of patients with chronic heart failure and to analyze the mediating effect of filialpiety values on the relationship between anxiety and caregiving burden. Methods During April 2017 to April 2018, 191children caregivers of patients with chronic heart failure from 3 secondary and tertiary medical institutions in Suzhou, Nanjing and Kunshan were selected to complete Visual Analogue Scale for Anxiety, Chinese Filial Values Index scale (FVI) and Dutch Objective Burden Inventory (DOBI). Results The total score of caregivers' anxiety, filialpiety values and caregiving burden were 3(0, 6), 96(84, 107) and 1(0, 9) respectively. Correlation analysis showed that the caregivers' anxiety was positively correlated with the caregiving burden (r=0.328, P<0.01), while filialpiety values were negatively correlated with caregiving burden (r=-0.537, P<0.01). Mediating-effect analysis showed that anxiety had a negative effect on filialpiety values (a=-0.61, P=0.02), and had a positive effect on caregiving burden (c=0.64, P=0.01). The filialpiety values had a negative effect on caregiving burden (b=-0.43, P<0.01). Filialpiety values played a partial mediating role between anxiety and caregiving burden (c' = 0.26, P＜0.05). Conclusions Medical staff should establish targeted interventions to improve caregivers′filialpiety values, thereby reducing their caregiving burden.

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Objective@#To understand the filialpiety values, anxiety and caregiving burden of caregivers of patients with chronic heart failure and to analyze the mediating effect of filialpiety values on the relationship between anxiety and caregiving burden.@*Methods@#During April 2017 to April 2018, 191children caregivers of patients with chronic heart failure from 3 secondary and tertiary medical institutions in Suzhou, Nanjing and Kunshan were selected to complete Visual Analogue Scale for Anxiety, Chinese Filial Values Index scale (FVI) and Dutch Objective Burden Inventory (DOBI).@*Results@#The total score of caregivers' anxiety, filialpiety values and caregiving burden were 3(0, 6), 96(84, 107) and 1(0, 9) respectively. Correlation analysis showed that the caregivers' anxiety was positively correlated with the caregiving burden (r=0.328, P<0.01), while filialpiety values were negatively correlated with caregiving burden (r=-0.537, P<0.01). Mediating-effect analysis showed that anxiety had a negative effect on filialpiety values (a=-0.61, P=0.02), and had a positive effect on caregiving burden (c=0.64, P=0.01). The filialpiety values had a negative effect on caregiving burden (b=-0.43, P<0.01). Filialpiety values played a partial mediating role between anxiety and caregiving burden (c' = 0.26, P<0.05).@*Conclusions@#Medical staff should establish targeted interventions to improve caregivers′ filialpiety values, thereby reducing their caregiving burden.

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Objective To evaluate the efficacy and safety of preoperative intra-aortic balloon pump(IABP) insertion in acute myocardial infarction(AMI) without cardiogenic shock(CS) patients receiving off-pump coronary artery bypass grafting ( OPCABG).Methods 444 consecutive AMI patients who underwent isolated OPCABG from January 2009 to December 2016 were enrolled.158 patients who underwent preoperative IABP placement(IABP group) and the other of 286 patients who did not have IABP placement(control group).The in-hospital mortality rate, postoperative complications, mechanical ventilation time, ICU stay and hospital length were compared between the two groups.Results The overall mortality was 5.0%.135 pairs of patients were matched.The preoperative IABP insertion showed benefits in postoperative survival rate compared with the control group(0 vs.5.9%, P＝0.004).However, patients with preoperative IABP were more likely to prolong duration of mechanical ventilation and ICU stay.The postoperative length of stay in hospital didn't show significant difference between the two groups.Conclusion Survival advantage was observed from preoperative IABP insertion in AMI patients without CS under-going OPCABG.

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Medical device standards provide effective technique foundation for supervision to ensure medical device safety for the people. With the optimization and upgrading of the medical device industry, the medical devices standard system including law and regulation system, organization management system, and technical management system has been advanced and developed. According to the requirements of the development of medical device industry and its standards, we put forward four working ideas, in order to improve the scientificity and applicability of medical device standards.

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Objective To translate and revise the Atrial Fibrillation-Quality of Life -18 (AF-QoL-18),and to test its reliability and validity. Methods The Chinese version of AF-QoL-18 was developed through the process of translation, back- translation, cultural adaptation, and preliminary experiment. A total of 187 atrial fibrillation (AF) patients in eight hospitals in Jiangsu province were investigated using the Chinese version to test the reliability and validity. Results Exploratory factor analysis identified three factors, including physiological, psychological and sexual dimensions, which could explain 65.055%of the total variance. The content validity index was 0.969. The Cronbach α coefficient was 0.915 and the retest reliability was 0.948 for the total scale. Conclusions The Chinese version AF-QoL-18 has proved to be reliable and valid.It can be used to measure the quality of life of AF patients in China.

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Objective To explore the association between human papilloma virus(HPV)infection and antisperm antibodies(As-Ab)in male infertile patients in Xinjiang area.Methods A total of 127 cases of infertile male patients were selected as experimental group,other 130 cases of normal male were enrolled in the control group.HPV sperm infection was detected by using reverse dot blot hybridization kit.The levels of AsAbs in semen specimen were measured by using the enzyme-linked immunosorbent assay (ELISA).Results The infection rate of male infertile patients(67.7%)was higher than that of normal male(1 6.2%),with signifi-cant differences(P <0.05).The positive rate of AsAb of male infertile patients with HPV infection(38.4%)was higher than that of male infertile patients without HPV infection(1 7.1%),with significant differences(P <0.05).Compared with male infertile pa-tients without HPV infection,the percentages of sperm motility and grade (a+b)sperm motility were decreased in male infertile pa-tients with HPV infection,wihile the sperm malformation rate was increased in male infertile patients with HPV infection,with sig-nificant differences(P <0.05).Conclusion The HPV infection rate of male infertile patients is relatively high in this area.HPV sperm infection could be associated with AsAb that may further reduce male fertility.

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Through the analysis of the present problems of the quality of medical device standards in China, combined with the development trend of the last ten years of medical devices, the paper made proposals on the medical device standards quality evaluation system, so as to improve the medical device standards management level and the quality of medical device standard in our country.

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This paper introduces the current status of Chinese medical device testing and inspection institutes. There are 53 such institutions, including 10 national institutions. Medical device testing and inspection institutions service in government regulation and supervision of medical devices, playing a technique support role for medical devices from registration before appear on market to monitor and supervision after listing. Meanwhile, they are important practitioners of medical devices standardization work. Finally, put forward the current problems and countermeasures of the inspection institutes in order to facilitate the sustainable development of our national medical equipment.

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Objective To investigate the distribution and drug resistance of the gram positive bacteria isolates from hospital in Chongqing during 2006-2011 .Methods Non-repetitive gram positive bacterias were collected retrospectively from ten hospitals in Chongqing .Antimicrobial susceptibility testing of all clinical isolates were carried out using Kirby-Bauer(KB) .Results 14 473 strains were isolated .There were 4 840 strains of Staphylococcus aureus (33 .4% ) ,2 566 strains of Staphylococcus epidermidis (17 .7% ) ,1 822 strains of Staphylococcus haemolyticus (12 .6% ) ,1 325 strains of Enterococcus (E .faecalis/E .faecium )(9 .2% ) . Staphylococcus was highly sensitive to nitrofurantoin ,rifampicin ,piperacillin/tazobactam ,linezolid ,teicoplanin and vancomycin ,but their resistance rate to ampicillin/sulbactam ,oxacillin ,penicillin and clarithromycin was high .The resistance rate of E .faecium to the majority of antimicrobial agents was obviously higher than that of E .faecalis ,excluding imipenem ,chloramphenicol and tetracy-cline .Vancomycin and linezolid still remain the strongest antibacterial activity to Enterococcus .Conclusion The distribution and drug resistance of pathogenic bacteria in Chongqing present regional particularity ,and antibiotic resistance is severe .It is significant to strengthen the epidemiology study of pathogenic bacteria and to develop policies to intervene in the use of antimicrobial agents .

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Medical device test is a very important step of medical device registration processes and is also a procedure to confirm whether the medical devices comply with applicable standards. The standardization system is imperfect yet in China due to the complexity of medical devices and the specialty of medical device industry. In this circumstance, the medical device standard is not only the important criteria for the medical devices registration, but also an important practical procedure of the medical device registration. This paper reviews the existing questions and also gives some comments and suggestions on the medical device standardization system from the view point of medical device test.

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Objective To explore factors affecting long-term compliance to weight management (WM) of patients with congestive heart failure (CHF)and to provide evidence for improving patients' compliance.Methods In-depth semi-structured interviews based on reinforcement theory were conducted among 18 CHF patients who received WM intervention over 6 months.The data were analyzed by Colaizzi analysis program.Results Three themes were found:precipitating factors such as the correct perception of disease and self-efficacy,the factors of positive reinforcement such as early gains from WM,readmission,follow-up,family and social support,as well as the factors of negative reinforcement such as gaining nothing during long period,physical and mental disorders.These above factors made long-term compliance to WM of 50％ of the participants dynamic and fluctuant.Conclusions Medical staff should identify patients'compliance at different stages in time during follow-up,analyze the factors that affect their compliance,and then grasp the optimal timing of intervention to perform targeted,multiform and multiple health education to improve compliance.

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This paper introduces the perioperative care of twelve chronic heart failure patients treated with cardiac resynchro-nization therapy,such as psychological care and correction of heart function during perioperative period, careful preparation of rescue instruments and observation of patients' conditions during the operation, intensive electrocardio monitoring,prevention of incision infection,nursing care of body position,and observation and treatment of postoperative complications during the postop-erative period. All the patients passed through the perioperative period safely and were discharged upon recovery. After a 1-6 months' follow-up,the patients' symptoms of heart failure was significantly improved and the exercise capacity was increased.

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There has been increasing attention over the past few years on the potential for the medical devices to cause changes in the immune systems, and it was necessary to provide guidance on how to address the adverse effects of medical devices on the immune system. Here we introduce the principles and methods for immunotoxicology testing of medical devices.

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