Objective To report a case of gastric ulcer associated with cytomegalovirus (CMV) infection in immunocompetent for improving the clinical recognition of the disease. Methods A 69-year-old patient with gastric ulcer caused by CMV infection was admitted to the 900th Hospital of the Joint Logistics Team on August 10, 2020. Biopsies were performed at the gastric ulcer and biopsy gastric mucosa samples were measured by hematoxylin-eosin (HE) staining and immunohistochemistry.The microscopic characteristics of the mucosal tissues, diagnosis and treatment experience of this case were analyzed and summarized. A literature review about CMV infection in gastric in inmmunocompetent patients was performed using PubMed search from database inception to July 2021. Results A total of 20 literatures were retrieved, involving 57 patients. A total of 58 patients were included in this article, including 39 males (67.2%) and 19 females (32.8%), with a ratio of men to women of 2.05:1. The average onset age of male was (52.4±16.0) years old, while (72.3±17.7) years old in female. The overwhelming majority of those patients were complicated with hypertension or type 2 diabetes mellitus. The most common symptoms were upper abdominal pain and gastrointestinal bleeding. The antrum of stomach was the most frequently affected site in gastric CMV disease, isolated gastric ulcer and multiple mucosal erosion were the main endoscopic appearance. CMV inclusion bodies were found either at the ulcer base or at the ulcer edges. There were 51.1% (24/47) of the patients treated with ganciclovir. However, 48.9% (23/47) of the patients were cured by symptomatic treatment. Conclusions On no consideration can clinically ignore CMV gastritis in adults without apparent immunosuppression when the symptoms as hematemesis, melena, and abdominal pain occur and antral gastric ulcer or multiple mucosal inflammation is seen endoscopically. Biopsies for CMV related tests, especially for pathological examination or histopathologic diagnosis are recommended. Antiviral therapy in people with clinical risk factors is essential for management of gastric CMV disease.

Objective To investigate the mechanism of artificial ulcer fibrosis of stenosis after full circumcision of esophageal mucosal dissection in porcine model based on TGF-β₁/Smads/ACTA2 signaling pathway. Methods A total of eight pigs were randomized into two groups (4 in each group): sham operation group and model group. Animals in the model group received full circumcision of ESD to establish the esophageal artificial ulcer fibrosis model. Three weeks after the surgery, we collected esophageal tissues from animals. We further analyzed the tissues with Hematoxylin-eosin (HE) staining to observe the pathological characteristics of esophageal tissues. The real-time quantitative polymerase chain reaction (qRT-PCR) was employed to detect the mRNA relative expression levels of TGF-β₁, Smad2, Smad3, and ACTA2. We then examined the positive expression of CTGF and ACTA2 using immunohistochemistry. Lastly, we detected the protein relative expression levels of TGF-β₁, Smad2/3,p-Smad2/3, Smad4, Smad7, CTGF, and ACTA2 using Western blotting. Results Compared with the sham operation group, the fibroblasts in the artificial ulcer site proliferated rapidly with a more transformed myofibroblast phenotype in the model group. In the model group, the qRT-PCR results showed up-regulated mRNA levels of TGF-β₁ (P<0.001), Smad3 (P=0.004), and ACTA2(P=0.001). The results of immunohistochemistry showed that the positive expression of CTGF (P<0.001) and ACTA2 (P<0.001)in the model group were higher than those in the sham operation group. We also observed up-regulated levels of TGF-β₁ (P=0.002),Smad2/3 (P=0.003), p-Smad2/3 (P=0.002), Smad4 (P<0.001), Smad7 (P=0.016), CTGF (P<0.001), and ACTA2 in the model group, compared with the sham operation group. Conclusion A porcine model of stenosis after full circumcision of esophageal mucosal dissection was successfully established, and the mechanism may be related to the artificial ulcer fibrosis by TGF-β₁/Smads/ACTA2 signaling pathway.

The incidence and mortality of malignant tumors are gradually increasing all the world, and the existing diagnosis and treatment methods still can not effectively block the occurrence and development of tumors. Some studies have found that cancer stem cells (CSCs) are the cells of tumor origin, and closely related to the occurrence, development and metastasis of tumors.Early detection and intervention with effective treatment of CSCs are expected to prevent the occurrence and development of tumors. Many studies have shown that the activation of Wnt/β-catenin signaling pathway is an important link in the initiation of CSCs and the formation of tumors. Therefore, by regulating the key upstream and downstream factors of the Wnt/β-catenin pathway in CSCs, thereby regulating the activity of the Wnt/β-catenin signaling pathway, controlling tumor growth and metastasis,can provide new targets and directions for the treatment and prevention of malignant tumors. The key role of Wnt/β-catenin signal pathway in CSCs, and the related mechanisms of the important factors of the pathway in regulating the tumor growth, development and metastasis of CSCs in different organs are reviewed in present paper.

Objective To investigate the influencing factors for prognosis in non-severe (mild to moderate) pulmonary acute respiratory distress syndrome (ARDS) patients, and evaluate the efficacy of the risk factors to predict the prognosis. Methods The data of 123 patients with non-severe pulmonary ARDS, hospitalized in the Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital (West Campus) from January 2017 to June 2021, were retrospectively enrolled, and divided into two groups according to 30-day survival condition, i.e., non-survivor group (n=45) and survivor group (n=78). Baseline characteristics, complications, arterial blood gas, blood routine, and levels of fibrinogen, C-reactive protein (CRP), procalcitonin,albumin and brain natriuretic peptide (BNP) were compared between the two groups. Kaplan-Meier and Cox survival analysis were adopted to analyze the risk factors which could affect the survival situation of patients with non-severe pulmonary ARDS.ROC curves were used to assess the efficacy of the risk factors to predict prognosis. Results Compared with survivor group, the proportion of patients with renal insufficiency, deep venous thrombosis and shock, APACHE Ⅱ score, body temperature, respiratory rate, neutrophil to lymphocyte ratio (NLR), fibrinogen and CRP levels in non-survivor group increased, and arterial partial pressure of carbon dioxide (PaCO₂), platelet count and albumin levels decreased (P<0.05). Kaplan-Meier survival analysis showed that kidney failure, deep venous thrombosis and shock were the risk factors of 30-day death in patients with non-severe pulmonary ARDS (P<0.05). Univariate Cox analysis demonstrated that heart rate, temperature, respiratory rate, PaCO₂, NLR, WBC, platelet count, fibrinogen, CRP, albumin and APACHE Ⅱ score were the risk factors of 30-day death in patients with non-severe pulmonary ARDS (P<0.05). Multivariate Cox analysis showed that higher APACHE Ⅱ score (HR=1.094, 95%CI 1.009-1.120, P=0.031), higher NLR (HR=1.087, 95%CI 1.012-1.167, P=0.021) and the presence of shock presented during course (HR=3.135, 95%CI 1.315-6.964, P=0.010) were independent risk factors for 30-day death of patients with non-severe pulmonary ARDS. The cut-off value of APACHE Ⅱ score and NLR in predicting mortality were 16.5 and 8.13, and the area under the curve (AUC) were 0.803 (95%CI 0.727-0.879) and 0.772 (95%CI 0.688-0.856), respectively. Conclusions APACHE Ⅱ score >16.5, NLR >8.13 and presence of shock were the independent risk factors of mortality for patients with non-severe pulmonary ARDS, and these factors could effectively predict prognosis.

Objective To screen and validate the traditional Chinese medicine (TCM) monomer that may regulate adipocyte function and improve obesity. Methods Data sets GSE70353 and GSE72158 were downloaded from Gene Expression Omnibus(GEO) database. The former contains 770 men (45-73 years old) with different BMI corresponding gene expression in subcutaneous white adipose tissue (SAT), and the latter contains 42 women (before and 1 year after bariatric surgery) corresponding SAT. The differentially expressed genes (DEGs) of data sets GSE70353 and GSE72158 in GEO were analyzed with R language, and the co-expressed DEGs of the two data sets were screened. Functional annotation Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of co-expressed DEGs were conducted by R language,protein-protein interaction (PPI) network construction and the hub genes screening were completed by STRING database and Cytoscape software. Connectivity map (cMAP) was used to screen the TCMs that can regulate the hub gene. The bergenin (0, 0.4, 2,10 μmol/L) and ginkgolide A (0, 0.01, 0.1, 1 μmol/L) were selected to treat mature white adipocytes (WAT) induced by 3T3-L1 cells for 24 h. The mRNA levels of interleukin-6 (IL-6) and peroxisome proliferator-activated receptor γ (PPARγ) were detected by qRT-PCR. Results There were 64 co-expressed DEGs in the two data sets, GO and KEGG analysis showed that DEGs were enriched in immune cell chemotaxis, complement-related cascade activation, and various inflammatory signaling pathway, responding to nutrient and lipid protein. The 18 hub genes [APOB (up-regulated), ACP5, C1QB, C1QC, CCL2, CCND1, CD163, CD68, FCER1G, ITGB2,MMP9, MS4A6A, MS4A7, PLEK, SPP1, TNFRSF11B, TYROBP, VSIG4 (down-regulated)] were identified by Cytoscape. Twenty-eight TCMs that could regulate hub genes were screened by cMAP, and 22 of them showed the ability of improving obesity. Compared with the control group, the mRNA level of PPARγ decreased in 0.4 μmol/L bergenin group and 0.1 μmol/L ginkgolide A group(P<0.05), and IL-6 mRNA levels decreased in 0.4 μmol/L bergenin group, 10 μmol/L bergenin group and 0.1 μmol/L ginkgolide A group (P<0.05). Conclusion A total of 28 TCMs were screened, of which 22 TCMs have been proved to be able to improve obesity.It has been initially confirmed in present study that bergenin and ginkgolide A could regulate the function of adipocyte.

Artificial intelligence has made breakthroughs in medicine in the past decade. Compared with the traditional statistical model, the advantage of artificial intelligence is that it can establish algorithm and prediction model through machine learning to efficiently and effectively identify the patterns in large data sets, and combine a variety of factors to create more accurate prediction model. Therefore, artificial intelligence is particularly suitable for huge and complex or high-dimensional clinical data analysis and predictive modeling tasks. There are many kinds of data formats in the clinical practice of hepatology. Many studies have applied artificial intelligence in the diagnosis and classification of liver diseases, assisting treatment, predicting efficacy and prognosis, and evaluation of liver imaging and pathology. Based on the study outcomes in related fields at home and aboard, this paper summarizes the research progress and application of artificial intelligence in the field of diagnosis and treatment of chronic liver diseases.

Objective To investigate the effects of treadmill exercise on the motor function and mammalian target of rapamycin (mTOR) signal pathway in motor cortex of adult mice with spinal cord injury. Methods Thirty C57BL/6J mice were randomly divided into sham group, model group and treadmill exercise group (10 each). All mice received pre-training for 3 days, and those in model group and treadmill exercise group were crushed with C₅ after pre-training in dorsal cortico-spinal tract,left cortico-spinal tract and rubro-spinal tract. The lamina was removed without damaging the spinal cord in sham group. Mice in treadmill exercise group began to run on the platform 1 week after injury, 5 days every week for 4 weeks. The motor function recovery was assessed with Basso Mouse Scale (BMS), horizontal ladder and cylinder rearing tests. The expression of insulin-like growth factor 1 (IGF-1), brain-derived neurotrophic factor (BDNF) and the phosphorylated level of tyrosine kinase receptor B (TrkB), insulin-like growth factor 1 receptor (IGF-1R), protein kinase B (Akt), and ribosomal S6 protein (S6) in motor cortex of mice were detected by Western blotting. The activation of cortical mTOR pathway was evaluated with immunofluorescence staining to detect the phosphorylated level of S6 in motor neurons. Results After injury, the BMS score of mice in model group and treadmill exercise group decreased briefly (P<0.0001), and recovered back to baseline level within 7 days. Compared with sham group, the error rate of left forelimb and left hindlimb increased (P<0.001) both in model group and treadmill exercise group 3 days, 1 week, 3 weeks and 5 weeks after injury. Compared with model group, the error rate of both left forelimb and left hindlimb decreased (P<0.001) in treadmill exercise group 3 and 5 weeks after injury. Compared with sham group, the utilization rate of left forelimb decreased (P<0.0001) both in model group and treadmill exercise group 3 days and 1 week after injury;and 3 and 5 weeks after injury, the utilization rate of left forelimb was still lower in model group than in sham group (P<0.001),while no statistical significant difference between the treadmill exercise group and sham group (P>0.05). Western blotting and immunofluorescence staining results showed that compared with sham group, the relative expression levels of BDNF and IGF-1 and the phosphorylation levels of TrkB, IGF-1R, Akt and S6 in the motor cortex of model group and treadmill exercise group decreased obviously, and the fluorescence intensity of p-S6 staining in neurons significantly decreased (P<0.01). Compared with model group, the relative expression levels of IGF-1, BDNF and the phosphorylation levels of TrkB, IGF-1R, Akt and S6 in the motor cortex of mice in treadmill exercise group increased significantly, and the fluorescence intensity of p-S6 staining in neurons significantly increased in treadmill exercise group (P<0.01). Conclusion The treadmill exercise is beneficial to the recovery of motor function in mice with spinal cord injury, which may be related to exercise-induced the expressions of BDNF, IGF-1 and activation of mTOR in motor cortex.

Objective To investigate the current situation of patients with adrenocortical carcinoma (ACC) in China,for providing references to clinical diagnosis and treatment of ACC. Methods The information was collected of patients (from adrenocortical tumor patient group) definitely diagnosed as ACC from 2010 to 2019 by questionnaire, including gender, age, clinical manifestations, course of disease, surgical and adjuvant treatment methods and curative effects, and retrospective analysis was conducted. Results A total of 156 ACC patients were included with a male to female ratio of 1:1.33. Patients aged 40-60 years accounted for the highest proportion. Except one patient with bilateral adrenal tumors, the others were unilateral involved, and the proportion of left adrenal tumor was slightly higher than that of the right side. Eighty-one (51.9%) patients had adrenocortical hormone hypersecretion, 33 patients (21.2%) of them had manifestations of hypercortisolism such as full moon face, buffalo back,centripetal obesity, and muscle weakness, and 12 patients (7.7%) had spontaneous hypersecretion of two or more adrenal hormones, including cortisol. One hundred and forty-seven patients underwent surgery, of which open surgery accounted for the highest proportion (n=86, 55.1%), followed by laparoscopic surgery (n=51, 32.7%). The most common distant metastasis sites were liver(n=50, 32.1%), lung (n=46, 29.5%) and retroperitoneal lymph nodes (n=34, 21.8%). 79.5% of the studied population (n=124)used mitotane for adjuvant treatment, and 66.9% (n=83) of the patients started medication due to postoperative recurrence and metastasis. The median stable dosage of mitotane was 2.0 g. 64.4% (n=58) of the patients could achieve partial or complete response,26.7% (n=24) of the patients were in stable condition, and the remaining 8.9% (n=8) had disease progression. After the combined application of other adjuvant treatments was included in the analysis, no significant difference was observed in the response among the three groups of mitotane alone, mitotane combined with chemotherapy, and mitotane combined with other treatments (P>0.05). Conclusions Functional occupancy accounted for more than 50% in ACC patients, and the proportion of cortisol hypersecretion is the highest. Some patients are prone to retroperitoneal lymph node metastasis, therefore, lymph node dissection should be performed routinely in radical operations. As an essential adjuvant therapy, mitotane possesses high response rate when used alone or in conjunction with chemotherapy or other adjuvant medicines.

Surgical injury is a major stressor, because patients with adrenal insufficiency are unable to secrete enough cortisol during perisurgery, such as giving only physiological alternative doses of glucocorticoids can induce adrenal crisis, life-threatening.Based on this, in February 2020, the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK published the Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency.In order to better understand and learn from the guide and promote the standardization of perioperative glucocorticoid replacement therapy in patients with adrenal insufficiency in China, this paper explains the epidemiology of glucocorticoid, adrenal cortex and adrenal crisis and perioperative glucocorticoid supplementation from the main content of the guide.

Objective To identify the differentially expressed microRNA (miRNA, miR) in cervical squamous cell carcinoma (SCC) and explore the mechanism of critical miRNA on the occurrence and development of cervical cancer. Methods To identify differentially expressed miRNA, we employed bioinformatics methods to filter out miRNA under the conditions of |fold change(FC)|>2.5 and P<0.01. The RNA expressions of miR-205 and interleukin-32 (IL-32) were detected by in situ hybridization and qRT-PCR, respectively. We evaluated cell proliferation, migration, and invasion through CCK-8 and Transwell model. The protein level of matrix metalloproteinase-3 (MMP-2) and MMP-9 were quantified by Western blotting. Results Through bioinformatics analysis, we obtained 106 differentially expressed miRNA in cervical cancer, with 70 up-regulated and 36 down-regulated miRNAs. miR-205 was the most differentially expressed miRNA. We validated the overexpression of miR-205 in cervical squamous cell carcinoma by in situ hybridization and qRT-PCR (P<0.05). Overexpression of miR-205 could significantly promote the proliferation, migration, and invasion of cervical cancer cells (P<0.05). The overexpression or decreased expression of miR-205 can increase or inhibit the expression of IL-32 in cervical cancer cell lines HeLa and SiHa, and miR-205 can directly interact with the IL-32 promoter to increase the expression of target genes (P<0.05); the decreased expression of miR-205 and IL-32 inhibited the invasion of cells (P<0.05); moreover, the decreased expression of IL-32 could significantly inhibit the expression of the invasion-associated proteins MMP-2 and MMP-9 (P<0.05). Conclusion In cervical squamous cell carcinoma,miR-205 is dramatically up-regulated, potentially promoting the proliferation, migration, and invasion of cancer cells, which could further enhance the expression of MMP-2 and MMP-9 through IL-32 up-regulation, and ultimately improve the invasion ability of cervical cancer cells.