As the world is facing a sudden public health crisis and an aging population, mobile payment products are widely used in the epidemic because of their ease of transaction and contactless security. However, data show that there are few mobile payment users over 60 years old in China, and this emerging digital technology has excluded many silver-haired generations. Through market research, product analysis, and user interviews, this study finds that the reasons for the low usage of mobile payment products by older users in Chinese society include: poor product inclusiveness and the lack of acceptance of digital products by older people. Most research in this area has focused on using technology acceptance model (TAM) and creating "elder models" specifically for the elderly. However, traditional TAM and polarized "normal model" and "elderly model" product models have made it difficult to expand the inclusiveness of products. This study innovatively introduces an inclusive design approach to constructing a TAM to optimize existing mobile payment products. The study selects WeChat Pay, which has the highest usage rate in China, as the research object. Through qualitative and quantitative survey methods, the study deeply investigates the pain points and needs of silver-haired people and integrates them with the needs of regular users, distills the key influencing elements in the new model to build an inclusive TAM, and finally gives recommendations for inclusive and age-appropriate design. The optimized design of WeChat Payments is based on the recommendations. Finally, the usability test is conducted with 15 elderly and 15 normal users to verify that the optimized design is inclusive.

Several studies have reported that individuals engaging in non-suicidal self-injury (NSSI), especially borderline personality disorder (BPD), feel no or little pain during acts of NSSI. While individuals without comorbid mental disorders make the pain perception complex. Pain sensitivity, including pain threshold and tolerance, may be regarded as an indicator of engagement of NSSI, particularly NSSI-induced suicide. So, the meta-analysis aimed to collect the current evidence on pain sensitivity among individuals engaging in NSSI and to identify the correlation between them. Five databases were searched, and 20 studies were included based on inclusion criteria after screening 451 abstracts by two independent reviewers. Random effects and meta-analysis were performed on pain threshold, pain tolerance, and odds ratio (OR). Importantly, diagnostic criteria, covering the diagnostic and statistical manual mental disorders-IV (DSM-IV), DSM-V, clinical interview, questionnaire, and not mentioned criteria (N), and different groups, such as BPD with NSSI and NSSI, were subjected to subgroup meta-analysis. The meta-analysis showed significant main effects associated with large effect sizes for included outcomes, which revealed individuals with NSSI appearing greater pain threshold and pain tolerance than those without NSSI. Diagnostic criteria and different groups are the main factors of heterogeneity. We also found that pain sensitivity is not correlated to NSSI which may attribute to NSSI diagnostic criteria. More studies should need to investigate the relationship between pain sensitivity and NSSI based on NSSI diagnostic criteria. Pain sensitivity may be considered a predictive factor for clinical application in the future.Funding Information: NSFC grant (81822017, 31771215), National Key R&D Program of China (2020YFA0113600), Natural Science Foundation of Zhejiang Province, China (No. LY19H090015).Declaration of Interests: All authors declare no competing interests.

Objective:To evaluate the outcome of endoscopic submucosal dissection (ESD) of colorectal tumors, and to analyze the factors affecting the therapeutic efficacy of ESD.Methods:Clinical data of patients with colorectal tumors who were treated with ESD in Department of Gastroenterology in Beijing Hospital from November 2016 to December 2019 were reviewed. A total of 82 patients with pathologically confirmed colorectal adenoma or carcinoma of diameter ≥20 mm were included. The clinical features, ESD and pathological outcomes of the patients were analyzed.Results:All 82 lesions were single, with the mean diameter of 29.72±10.74 mm. Lesions were divided into the laterally spreading tumors (LST), mainly located in the ascending colon and ileocecal region (47.8%, 22 / 46) and the protruding colorectal tumors, mainly located in the left colon, 52.8% (19 / 36) of which were located in the sigmoid colon. The overall resection rate was 81.7%(67/82) and the curative resection rate was 72.0%(59/82). The incidences of bleeding and perforation were 2.4%(2/82) and 1.2%(1/82), respectively. The curative resection rates [91.4%(32/35), 63.6%(7/11) and 55.6%(20/36), P=0.003] and surgical operation rates [8.6%(3/35), 18.2%(2/11) and 36.1%(13/36), P=0.010] of LST-G, LST-NG and protruding colorectal tumors were significantly different. Multivariate regression analysis showed that protruding colorectal tumor ( OR=3.396, 95% CI: 1.014-11.374, P=0.047) and submucosal severe fibrosis (F2 type) ( OR=5.508, 95% CI: 2.216-13.692, P=0.001) were independent risk factors for non-curative ESD resection of colorectal tumors. Conclusion:ESD is effective and safe for colorectal tumors of diameter ≥ 20 mm. However, there are some differences in the rate of submucosal invasion and treatment outcome among different types of lesions. The risk factors for non-curative resection are protruding tumors and severe submucosal fibrosis.

Objective To explore the changes in microbial composition and the corresponding impact after lactitol treatment in constipated patients. Methods Altogether 29 consecutive outpatients diagnosed with chronic constipation from three centers were recruited and stratified based on their history of diabetes mellitus. All patients were administered with oral lactitol for 2 weeks, and a symptoms diary of constipation was recorded. Fecal samples were collected before and after lactitol treatment, and were analyzed by 16S rRNA sequencing and real-time polymerase chain reaction (PCR) to detect gut microbiota. Results Twenty patients with diabetes mellitus and nine without, all with chronic constipation, were enrolled in this study. After 2-week administration of lactitol, their subscale scores and constipation symptoms significantly decreased (P < 0.05). An analysis of fecal flora using 16S rRNA sequencing found an increasing trend of abundance ofBifidobacteriumin the post-lactitol group (P= 0.08). Actinobacteria, Actinobacteria, Bifidobacteriales, Bifidobacteriaceae andBifidobacteriumwere significantly more abundant after lactitol administration. Real-time PCR showed significantly high DNA copy numbers ofBifidobacteriumafter lactitol treatment (1.39 x 10(10)vs 2.74 x 10(9)copies/mu L,P= 0.01). The results of 16S rRNA sequencing and real-time PCR illustrated an increasing trend ofBifidobacteriumin both patients with and without diabetes. In addition,Bifidobacteriumwas negatively correlated with constipation subscale scores. Conclusions Alterations in fecal flora composition after lactitol supplementation, especially in terms of an increasing trend ofBifidobacterium, alleviated constipation symptoms. Lactitol may be a promising prebiotic candidate for patients with constipation, regardless of diabetes mellitus.

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

本研究通过回顾性分析2020年2月9至29日华中科技大学附属同济医院中法新城院区隔离病房北京医院国家援鄂抗疫医疗队收治的54例新型冠状病毒肺炎(COVID-19)患者的临床资料，比较不同临床分型患者的基本临床特征、入院时外周血生物化学指标检测结果，以及炎症指标如IL-6、超敏C-反应蛋白(HsCRP)和铁蛋白水平。结果发现COVID-19患者的消化系统症状并不少见，以腹泻(22.2%)和恶心(14.8%)为主，普通型患者的腹泻比例更是高达26.3%(10/38)，仅次于常见症状发热、乏力和咳嗽；患者外周血LDH、D-二聚体水平和炎症指标IL-6、HsCRP水平均与临床疾病分型相关，能够提示COVID-19的严重程度。

坏疽性脓皮病(PG)是一种罕见的慢性复发性溃疡性皮肤病，病因和发病机制不明，其组织病理学改变属于嗜中性皮肤病。多数PG患者伴有全身性疾病，其中最常见的是IBD、关节炎和血液系统疾病。部分患者可有非常罕见的皮肤外PG表现，累及肺、肠道、角膜、肝脏、脾脏、心脏、骨、肌肉和中枢神经系统等。现报告北京医院消化内科收治的1例由包皮切除术诱发血便继而诊断为PG的患者。

1例患者因便血查因就诊，完善消化道检查，考虑血管畸形导致消化道出血。影像检查过程中发现先天性脾缺如。考虑先天性脾缺如合并肠道血管发育畸形，静脉增粗，间断便血。该病临床罕见，故结合文献，对其诊治经过进行了报道。

目的 绘制ROC曲线探讨miR-375、miR-106b和AFP在肝癌早期诊断中的价值.方法 将我院2017年1月至2019年7月间收治的80例肝癌患者作为观察组,80例肝硬化或其他肝病患者作为对照组;检测患者血中miR-375、miR-106b和AFP水平,并绘制ROC曲线分析血清miR-375、miR-106b和AFP在肝癌早期诊断的价值.结果 观察组患者血中miR-375、miR-106b和AFP水平均明显高于对照组,且差异具有统计学意义(P＜0.05);miR-375、miR-106b和AFP是影响AFP发生发展的独立性影响因素(P＜0.05);miR-375、miR-106b和AFP联合鉴别诊断的灵敏度、特异性及AUC均明显高于各指标单独应用,且差异具有统计学意义(P＜0.05).结论 采用miR-375、miR-106b和AFP联合应用对肝癌进行早期诊断的AUC大于0.9,具有较高的应用价值.

本文报道了1例老年男性患者，因消化道出血就诊，既往曾行经皮冠状动脉支架介入手术，术后双联抗血小板治疗，胶囊内镜检查提示小肠多发隔膜样狭窄伴溃疡糜烂，符合非甾体类抗炎药引起小肠黏膜损伤表现。但追问病史，患者服用双联抗血小板药物治疗前曾有过小肠不全梗阻病史，因此小肠黏膜的病变是先天存在还是药物相关尚值得思考。

Aim: We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing. Methods: In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6). Results: The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%). Conclusion: N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.

目的 评价菱形结构域蛋白1(RHBDD1)、胃蛋白酶原(PGⅠ、PGⅡ)以及癌胚抗原(CEA)在慢性萎缩性胃炎的筛查中的作用,评价其对胃癌早期诊断的价值.方法 收集2016年1月至2017年1月在北京医院接受胃镜及胃黏膜病理检查的患者共78例.根据病理结果将研究对象分为慢性浅表性胃炎(CSG)11例、慢性萎缩性胃炎(CAG)18例、低级别上皮内瘤(LGIN)10例、早期胃癌(EGC)23例、进展期胃癌(AGC)16例.分别检测各组患者的血清CEA、胃蛋白酶原、RHBDD1,应用统计学方法对上述检验结果进行统计分析.结果 PGⅠ/Ⅱ在5组间比较差异明显(P<0.05);两两比较中,CSG-EGC、CSG-AGC、CAG-AGC和LGIN-AGC组间差异明显(P<0.05).以胃炎-早期胃癌-进展期胃癌分组,CEA及PGⅠ/Ⅱ具有统计学差异(P<0.05);RHBDD1呈上升趋势.结论 PGⅠ/Ⅱ水平减低对早期胃癌具有诊断价值,可用于胃癌高危患者的早期筛查.

目的 研究抗栓治疗的老年患者内镜下行结肠息肉切除的安全性.方法 筛选住院行结肠息肉切除的2299例抗栓治疗老年患者的病历资料进行回顾性分析,其中高血压病及冠心病患者合计1555例(高血压冠心病组),冠心病支架置入术后患者435例(冠脉支架放置组),人工心脏瓣膜置换术后及心房颤动患者合计309例(人工心脏瓣膜+心房颤动组).比较各组不良事件发生情况,对比分析围术期不同抗栓药物管理方案与发生出血事件及血栓栓塞的关系.结果 冠脉支架放置组出血事件及血栓栓塞发生率高于高血压冠心病组及人工心脏瓣膜+心房颤动组,差异有统计学意义(P<0.05),行结肠息肉切除术前3～5 d停用抗凝药物出血事件及血栓栓塞发生率分别为2.00％,2.49％,术后<3 d恢复抗凝药物出血事件及血栓栓塞发生率分别为3.34％,1.45％,息肉≥1 cm患者内镜切除后出血事件发生率高于息肉<1 cm患者,差异有统计学意义(P<0.05),低分子肝素桥接抗凝治疗患者出血事件发生率对比未桥接抗凝患者差异无统计学意义(P>0.05).结论 结肠息肉切除术前3～5d停用抗栓药物,术后<3d恢复抗栓药物可有助于提高抗栓治疗老年患者结肠息肉内镜切除安全性.

老年人功能性便秘患病率高,严重影响老年人生活质量,引发心脑血管病等诸多疾患;其成因复杂,多与老年人的生理、病理、心理和全身器质性疾病及药物等因素相关,临床诊疗需要综合考量,注重整体与局部兼顾;中西医各有优势和不足,积极配合、互相借鉴、协同诊疗,将使老年人更大获益.

目的:观察匹维溴铵联合复方嗜酸乳杆菌治疗不同亚型肠易激综合征(irritable bowel syndrome,IBS)的临床效果及安全性.方法:联合应用匹维溴铵及复方嗜酸乳杆菌治疗便秘型及腹泻型肠易激综合征患者76例,其中,腹泻型39例,便秘型37例,连续用药4周,观察患者腹部症状和大便性状的改善.结果:腹泻型患者中有效34例,有效率87.2％;便秘型患者中有效25例,有效率67.6％;两组有效率有统计学差异,腹泻型肠易激综合征患者联合用药效果优于便秘型患者(x2=4.206,P＜0.05).两组均无明显不良反应.结论:匹维溴铵联合复方嗜酸乳杆菌治疗不同亚型肠易激综合征患者效果有差异,对腹泻型患者的效果优于便秘型患者.

Nonalcoholic fatty liver disease(NAFLD),which is a kind of irritable liver injury related to genetic and environmental factors,is considered as the manifestation of metabolic syndrome in the liver.Gut microbiota plays an important role in the intestinal environment.In recent years,increased numbers of studies have suggested that the imbalance of intestinal flora is closely related to NAFLD.This paper is to review the mechanism of gut microbiota in the pathogenesis and progression of NAFLD and to comment on gut microbiota-targeting new treatment of NAFLD by regulating the intestinal flora.

Objective To assess the value of endoscopic ultrasonography (EUS) and abdominal CT scan on preoperative T and N staging of advanced gastric cancer.Methods A total of 188 patients with advanced gastric cancer received EUS and CT scan to evaluate the T and N staging and lymphatic metastasis before surgical operation.The postoperative pathologic results acted as gold standard for comparison of the two methods.The results consistent with pathologic results were considered as correct otherwise were incorrect.The accuracy of EUS and CT and the each consistency of two methods with pathology were analyzed.Results For T staging, the accuracy of EUS and CT was 87.2%(164/188), 76.6%(144/188), respectively, and Kappa value of EUS and CT was 0.726 and 0.509, respectively.There was a statistical difference between the two methods(χ2=7.181,P=0.007).For lymph node metastasis, the accuracy of EUS and CT was 72.9%(137/188) and 79.8%(150/188), respectively, and Kappa value of EUS and CT was 0.397 and 0.487, respectively.No statistical difference was found between them(χ2=0.963,P=0.326).The consistency test between the two methods for T and N staging and lymph node metastasis revealed that the Kappa value was 0.507 and 0.649, respectively.The accuracy of EUS on T staging was 93.0%, 93.3%, 96.8% and 91.5% in cardiac cancer, gastric fundus cancer, gastric corpus cancer, and gastric antrum cancer, respectively.Corresponding Kappa value in the 4 different positions were 0.843,0.881,0.940 and 0.710, respectively according to consistency tests.The accuracy of gastric antrum cancer with pylorus invasion was 63.2% and the consistency test Kappa value was 0.340.Conclusion EUS is an accurate method for T staging and lymphatic metastasis of advanced gastric cancer, but there is a lower accuracy for T staging of gastric antrum cancer with pylorus invasion.