Xinli Mao's research while affiliated with Wenzhou Medical University and other places

Diabetes is a prevalent chronic disease that traditionally requires severe reliance on medication for treatment. Oral medication and exogenous insulin can only temporarily maintain blood glucose levels and do not cure the disease. Most patients need life-long injections of exogenous insulin. In recent years, advances in islet transplantation have significantly advanced the treatment of diabetes, allowing patients to discontinue exogenous insulin and avoid complications.Long-term follow-up results from recent reports on islet transplantation suggest that they provide significant therapeutic benefit although patients still require immunotherapy, suggesting the importance of future transplantation strategies. Although organ shortage remains the primary obstacle for the development of islet transplantation, new sources of islet cells, such as stem cells and porcine islet cells, have been proposed, and are gradually being incorporated into clinical research. Further research on new transplantation sites, such as the subcutaneous space and mesenteric fat, may eventually replace the traditional portal vein intra-islet cell infusion. Additionally, the immunological rejection reaction in islet transplantation will be resolved through the combined application of immunosuppressant agents, islet encapsulation technology, and the most promising mesenchymal stem cells/regulatory T cell and islet cell combined transplantation cell therapy. This review summarizes the progress achieved in islet transplantation, and discusses the research progress and potential solutions to the challenges faced.

There are significant risks of adverse events following oesophageal endoscopic submucosal dissection (ESD), such as stricture, delayed bleeding and perforation. Therefore, it is necessary to protect artificial ulcers and promote the healing process. The current study was performed to investigate the protective role of a novel gel against oesophageal ESD-associated wounds. This was a multicentre, randomized, single-blind, controlled trial that recruited participants who underwent oesophageal ESD in four hospitals in China. Participants were randomly assigned to the control or experimental group in a 1:1 ratio and the gel was used after ESD in the latter. Masking of the study group allocations was only attempted for participants. The participants were instructed to report any adverse events on post-ESD days 1, 14, and 30. Moreover, repeat endoscopy was performed at the 2-week follow-up to confirm wound healing. Among the 92 recruited patients, 81 completed the study. In the experimental group, the healing rates were significantly higher than those in the control group (83.89 ± 9.51% vs. 73.28 ± 17.81%, P = 0.0013). Participants reported no severe adverse events during the follow-up period. In conclusion, this novel gel could safely, effectively, and conveniently accelerate wound healing following oesophageal ESD. Therefore, we recommend applying this gel in daily clinical practice.

Chronic gastritis mainly includes chronic non-atrophic gastritis(CNAG), autoimmune gastritis (AIG), and type B gastritis. Early detection of AIG and type B gastritis will help identify high-risk groups for gastric cancer and prevent the development of irreversible peripheral neuropathy. We aim to develop a computer-assisted diagnosis (CADx) system by presenting a novel Convolution and Relative Self-Attention Parallel Network (CRSAPNet). We collected 3576 endoscopic images of chronic gastritis from 205 patients. MBConv and Relative Self-Attention Parallel Block (CRSAPB) was proposed to concatenate local features (such as mucosal folds and mucosal vessels extracted by MBConv) and global features (such as atrophied area extracted by Relative Self-Attention) in parallel in the last two stages of CRSAPNet. The CADx system distinguished AIG from type B gastritis and CNAG. The CRSAPNet achieved the highest overall accuracy of 95.44% (94.65% precision, 93.51% recall, 94.08% F1-score for AIG) with the fewest parameters. We used Grad-CAM to visually analyze the heat maps. We only replaced the original blocks of the third stage of ResNet50 and ConvNeXt-T with CRSAPB, resulting in an overall accuracy improvement of 0.37%, and 4.19%, respectively. Furthermore, the CADx system classified the three types of chronic gastritis for the first time. The CRSAPNet achieved an overall accuracy of 91.62%, and the overall accuracies in the location of the gastric body and gastric fundus were 93.43% and 92.51%, respectively. A new state-of-the-art deep learning network is introduced to distinguish AIG from type B gastritis and CNAG, and a classification for three types of chronic gastritis is reported for the first time.

Background: To improve the eradication rate of H. pylori, researchers have investigated the role of WeChat-based mini-app as an electronic reminding system in H. pylori treatment. Methods: Subjects from three medical centers were divided into two groups. Patients in the daily mini-app-based notification system group received daily notifications via the WeChat mini-app. Patients in the control group received one-time verbal education on the first clinical visit. Both groups received a 14-day quadruple therapy to eradicate H. pylori infection. Eradication rate, compliance, adverse events and satisfaction were evaluated. Results: Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. The eradication rate in the daily mini-app-based notification system group was slightly higher compared with the control group (ITT analysis: 76.70% vs. 70.73%, p = 0.312; PP analysis: 85.87% vs. 82.86%, p = 0.562). The compliance was significantly higher in the daily mini-app-based notification system group (ITT analysis: 85.52% vs. 70.48%, p = 0.028; PP analysis: 92.39% vs. 81.90%, p = 0.030). The adverse event rates were similar between the two groups (PP analysis: 36.96% vs. 40.95%, p = 0.566). No significant difference in eradication rate was seen in each subgroup analysis by age, place of residence, grade of education, or endoscopic findings. Conclusion: The study showed that daily mini-app-based notification improved patient compliance but not H. pylori eradication rate. Trial registration The research was registered in the Chinese Clinical Trial Registry (ChiCTR2000031011, 21/03/2020).

There are significant risks of adverse events such as stricture, delayed bleeding and perforation following esophageal endoscopic submucosal dissection (ESD). So, it is necessary to protect the artificial ulcer and promote the healing process. This study was performed to investigate the protective role of a novel gel against esophageal ESD-associated wounds. It was a multicenter, randomized, single-blind, controlled trial, which recruited participants who underwent esophageal ESD in four hospitals in China. Participants were randomly assigned to the control or experimental group in a 1:1 ratio and the gel was used after ESD in the latter. Masking of the study group allocations was only attempted for participants. The participants were instructed to report any adverse events on post-ESD day 1, 14, and 30. Moreover, repeat endoscopy was performed at the two-week follow-up to confirm wound healing. Finally, of the 92 recruited patients, 81 completed the study. In the experimental group, the healing rates were significantly higher than the control group (83.89 ± 9.51% vs. 73.28 ± 17.81%, P = 0.0013). Participants reported no severe adverse events during the follow-up period. In conclusion, this novel gel could accelerate wound healing following esophageal ESD safely, effectively, and conveniently. Therefore, we recommend to apply this gel in daily clinical practice.

Background: Although associated with high en bloc and complete resection rates, endoscopic resection, which is widely performed for gastrointestinal mucosal and submucosal lesions, may cause bleeding and perforation. However, novel agents are being introduced to minimize these complications. Methods: In this multicenter, randomized, single blind, controlled trial, participants who underwent colonic endoscopic resection across four hospitals in China were randomly assigned to the control or experimental group(1:1 ratio); the gel was used after colonic endoscopic resection in the latter. Participants were instructed to report adverse events on the first day, 14th day, and one-month post-intervention. Repeat endoscopy was performed at two-week follow-up to confirm resection site healing. Results: Of the 92 screened participants, 73 completed the study. Each ulcer bed was successfully coated with the gel over an 87.4±13.4% area within approximately three minutes in the experimental group. The calculated healing rates were significantly higher in the experimental than in the control group (84.7±10.8% vs. 72.6±16.0%, P=0.0004). No severe relative adverse event occurred during follow-up. Conclusions: This novel gel is a safe, effective, and convenient agent that promotes wound healing after colonic endoscopic resection. And we recommend application of this gel to protect the ulcer bed in daily clinical practice. Trial registration This trial has been registered in Chinese Clinical Trial Registry (ChiCTR2100053692).

The Yes‐associated protein‐1 (YAP1) is an essential regulator of human Hippo signaling pathway and functions through interaction with TEA domain‐4 (TEAD4) transcription factor involved in the tumorigenesis of nasopharyngeal cancer. Previously, a parallel helix–helix interaction (PHHI) was identified as the key hotspot at YAP1–TEAD4 complex interface and has been exploited as an attractive druggable target to disrupt the complex. In this study, we investigated a roughly orthogonal cation‐π‐π stacking system across the crystal PHHI packing interface by integrating computational modeling and binding assay, which forms between one YAP1 helical residue Phe69 and two TEAD4 helical residues Phe373/Lys376. A synergistic effect between cation‐π and π‐π interactions was observed; they separately represent two wings of the stacking system. The π‐electron is primarily responsible for the synergistic effect. Combination between diverse aromatic/charged amino acids as well as neutral alanine on the cation‐π‐π stacking revealed that the presence of aromatic tryptophan and charged arginine at, respectively, the residues 373 and 376 of TEAD4 helix can considerably improve PHHI binding affinity by ~6‐fold, whereas neutral alanine substitution on each residue and on both would reduce the affinity significantly, confirming a strong synergistic effect involved in the roughly orthogonal cation‐π‐π stacking system at YAP1–TEAD4 PHHI interface. This article is protected by copyright. All rights reserved.

Background Artificial intelligence (AI) assistance has been considered as a promising way to improve colonoscopic polyp detection, but there are limited prospective studies on real-time use of AI systems. Methods We conducted a prospective, multicenter, randomized controlled trial of patients undergoing colonoscopy at six centers. Eligible patients were randomly assigned to conventional colonoscopy (control group) or AI-assisted colonoscopy (AI group). AI assistance was our newly developed AI system for real-time colonoscopic polyp detection. Primary outcome is polyp detection rate (PDR). Secondary outcomes include polyps per positive patient (PPP), polyps per colonoscopy (PPC), and non-first polyps per colonoscopy (PPC-Plus). Results A total of 2352 patients were included in the final analysis. Compared with the control, AI group did not show significant increment in PDR (38.8% vs. 36.2%, p = 0.183), but its PPC-Plus was significantly higher (0.5 vs. 0.4, p < 0.05). In addition, AI group detected more diminutive polyps (76.0% vs. 68.8%, p < 0.01) and flat polyps (5.9% vs. 3.3%, p < 0.05). The effects varied somewhat between centers. In further logistic regression analysis, AI assistance independently contributed to the increment of PDR, and the impact was more pronounced for male endoscopists, shorter insertion time but longer withdrawal time, and elderly patients with larger waist circumference. Conclusion The intervention of AI plays a limited role in overall polyp detection, but increases detection of easily missed polyps; ChiCTR.org.cn number, ChiCTR1800015607.

Background Air pollution has already become a serious public health concern worldwide, while evidence for the association between air pollution and digestive disease is not consistent. Objective To examine the association between air pollution and peptic ulcer bleeding (PUB). Methods We performed a time-stratified case-crossover study among 1,246,270 gastroscopy records in Zhejiang, China from January 1st, 2013 to June 30th, 2019. Individual exposure to air pollution for each subject was estimated by using data from 55 fixed-sites with an inverse distance weighted method. Conditional logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for PUB associated with an interquartile range (IQR) increase in air pollution on the entire population. Subgroup analyses were performed for season, age and sex. Results Totally 3,543 patients diagnosed with PUB were included in the analyses. Significant associations were observed between NO2, CO and PM2.5 and the risk of PUB. The effect was observed strongest measured as lag06 and an IQR increase of 7-day moving average concentrations of NO2 resulted in a 24.0% increase of getting PUB (95% CI: 2.6%-50.0%). Significance Our findings strengthen the hypothesis that short-term air pollution exposure has adverse health effects on digestive system.