Background and aimsGastric intestinal metaplasia (IM) is common in the gastric epithelium of patients with chronic atrophic gastritis. CDX2 activation in IM is driven by reflux of bile acids and following chronic inflammation. But the mechanism underlying how bile acids activate CDX2 in gastric epithelium has not been fully explored.MethodsWe performed microRNA (miRNA) and messenger RNA (mRNA) profiling using microarray in cells treated with bile acids. Data integration of the miRNA/mRNA profiles with gene ontology (GO) analysis and bioinformatics was performed to detect potential miRNA-mRNA regulatory circuits. Transfection of gastric cancer cell lines with miRNA mimics and inhibitors was used to evaluate their effects on the expression of candidate targets and functions. Immunohistochemistry and in situhybridisation were used to detect the expression of selected miRNAs and their targets in IM tissue microarrays.ResultsWe demonstrate a bile acids-triggered pathway involving upregulation of miR-92a-1–5p and suppression of its target FOXD1 in gastric cells. We first found that miR-92a-1–5p was increased in IM tissues and induced by bile acids. Moreover, miR-92a-1–5p was found to activate CDX2 and downstream intestinal markers by targeting FOXD1/FOXJ1 axis and modulating activation of nuclear factor kappa B (NF-κB) pathway. Furthermore, these effects were found to be clinical relevant, as high miR-92a-1–5p levels were correlated with low FOXD1 levels and high CDX2 levels in IM tissues.ConclusionThese findings suggest a miR-92a-1–5p/FOXD1/NF-κB/CDX2 regulatory axis plays key roles in the generation of IM phenotype from gastric cells. Suppression of miR-92a-1–5p and restoration of FOXD1 may be a preventive approach for gastric IM in patients with bile regurgitation.

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A new coronavirus was discovered after a cluster of pneumonia cases emerged in Wuhan City, Hubei Province, China, in December 2019 [1,2] and has since spread widely within China and to several countries. The World Health Organisation (WHO) declared the epidemic a Public Health Emergency of International Concern on 30 Jan 2020 and advised all countries to be prepared.Despite the timely and robust response compared to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, the epidemic continues to worsen. The lessons gleaned from our experience during the SARS epidemic [3,4] are still very relevant today as we get our interventional radiology (IR) service ready for this epidemic. While the following measures we propose may appear strict, it is prudent to be more proactive when dealing with a novel infection.First, patients with different infection risks are segregated by place where possible, or by time otherwise, to prevent cross-infections. This will entail performing procedures on isolated patients separate in place and time from other patients. Given the evidence of asymptomatic transmission [5], it may become necessary for all staff to wear a minimum of personal protective equipment for all procedures.Second, segregation of staff. For groups covering multiple hospitals, segregation of manpower to different sites will minimise the risk of cross-transmission. If intra-hospital transmission occurs, segregation of staff within institutions into independent teams will be needed to prevent shutdown of the entire team should a quarantine be required.Third, careful vetting and prioritising of requests, to assess both the infection risks and the urgency of each procedure. We have chosen to reduce our workload to allow for ramping up of infection control measures. One approach is to continue with urgent and elective oncologic procedures, while postponing an appropriate number of other elective cases. The IR clinic plays an important role in this regard for us to triage these patients and communicate directly the measures taken to protect them. Electronic medical records should make this process easier as clinical information is instantly available.Fourth, movement of isolated patients should be minimised, with a strong preference for portable bedside ultrasoundguided procedures. Transfers to predesignated procedural rooms may be inevitable for complicated cases. Potential routes should be planned with relevant colleagues in the institution to ensure swift and safe transfers.Fifth, enhanced workflows within the procedural suites should be structured and rehearsed so that each member is clear about his or her role. This will invariably require more manpower and time than usual.Lastly, strict adherence to WHO's infection prevention and control recommendations. Emphasis should be made to all staff that good infection control measures, hand hygiene, and careful donning and doffing of appropriate personal protective equipment remain our best defence. Where required, staff should be trained in the use of particulate (N95)

Helicobacter pylori (H. pylori) recurrence remains a significant public health concern. The study aimed to assess H. pylori reinfection rate and identify its risk factors in China. This prospective open cohort, observational study was performed at 18 hospitals across 15 provinces in China. Consecutive patients who received the successful initial eradication during 1 January 2012 and 31 December 2018 were eligible for enrolment. H. pylori recurrence was defined as reinfection that occurred at more than the 12-month interval after successful initial eradication. Surveyed risk factors that might be associated with reinfection were preliminarily estimated by log-rank test and further determined by Cox regression model to calculate the hazard ratio (HR) and 95% confidence interval (CI). A total of 5193 subjects enrolled in the study. The follow-up intervals varied from 6 to 84 months with a general follow-up rate of 67.9%. Annual reinfection rate was 1.5% (95% CI: 1.2-1.8) per person-year. H. pylori reinfection was independently associated with the following five risk factors: minority groups (HR = 4.7, 95% CI: 1.6-13.9), the education at lower levels (HR = 1.7, 95% CI: 1.1-2.6), a family history of gastric cancer (HR = 9.9, 95% CI: 6.6-14.7), and the residence located in Western China (HR = 5.5, 95% CI: 2.6-11.5) following by in Central China (HR = 4.9, 95% CI: 3-8.1) (all P < 0.05). Reinfection rate of H. pylori in China is relatively low. Patients with specific properties of ethnic groups, education level, family history, or residence location appear to be at higher risk for reinfection.