Plague is a virulent infectious disease caused by Yersinia pestis. There have been three plague pandemics in the world history, of which the third plague pandemic started in Yunnan, China in 1772, and became a global pandemic in 1894, affecting many countries in Asia, Europe, America, Oceania and Africa. It has been reported that the third plague pandemic was caused by the branch of Yersinia pestis 1.ORI. This paper summarizes the origin, transmission route, distribution area and ecological environment of 1.ORI clade and the relationship with the third plague pandemic, which has guiding significance for further understanding and studying the epidemiological pattern of plague, formulating appropriate surveillance programmes and prevention and control measures.

Objective To compare the contents of alkaloid in Aconiti Kusnezoffii Radix with different degrees of processing and their effects on electrocardiogram and vagus nerve action potential in SD rats;To establish a toxicity evaluation method for Aconiti Kusnezoffii Radix and its processed products.Methods HPLC was used to determine the contents of six alkaloid components,including benzoyl neoaconitine,benzoyl aconitine,benzoyl subeaconitine,neoaconitine,subeaconitine and aconitine in Aconiti Kusnezoffii Radix and Aconiti Kusnezoffii Radix Cocta of soaking and boiled for 30 minutes,boiled for 4 h without soaking,soaking and boiled for 4 h,and soaking and boiled for 8 h.SD rats were subjected to sublingual drainage with Aconiti Kusnezoffii Radix and four types of processed products.The vagus nerve action potential and electrocardiogram of rats before and after administration were recorded,and the correlation analysis between alkaloid content and vagus nerve action potential and heart rate was conducted.Results The contents of alkaloid of the four processed products showed that the content of diester alkaloids was soaking and boiled for 30 min>boiled for 4 h without soaking>soaking and boiled for 4 h>soaking and boiled for 8 h;monoester alkaloid content:boiled for 4 h without soaking>soaking and boiled for 30 min>soaking and boiled for 4 h>soaking and boiled for 8 h.After the administration of each sample,compared with the basal discharge,the vagus nerve discharge of rats with different processed products was changed by sublingual administration,heart rate increased,the degree of arrhythmia increased,and it varied with the degree of processing;the results of correlation analysis showed that there was a significant correlation between the nerve discharge area and the contents of diester alkaloids and total alkaloids.Conclusion The action potential of the vagus nerve and electrocardiogram of rats after sublingual drainage administration can reflect the degree of numbness in the tongue,which can provide reference for the study of tongue sensation of Aconiti Kusnezoffii Radix.

Objective To cultivate the ability of laboratory resident physicians in multiple aspects and enhance their post-competence for laboratory medicine.Methods The residents recruited into the Cancer Hospital of China Academy of Medical Sciences Laboratory Base were divided into junior residents and senior residents.According to the different training contents and objectives,the exploration of the hierarchically progressive training model was carried out,which mainly included three aspects:training plan,process training and process assessment.Results After the implementation of the hierarchical progressive training model,the average theoretical score and the average score in the skill operation examination of the residents increased to over 90 and 95,respectively.Meanwhile,the comprehensive clinical ability was also improved.Breakthroughs of teaching,scientific research and honor were achieved from"nothing"before the implementation to"something"after the implementation,and it actively promoted the improvement of the post-competency of the residents in laboratory medicine.Conclusion The application of the hierarchically progressive training mode in standardized training of residents in laboratory medicine could play a good role in promoting the training of post-competence for residents.

Objective: To study the effect of cardiac autonomic nerve function on body function and weakness in elderly diabetic patients. Methods: A total of 100 patients diagnosed as diabetic autonomic neuropathy in the endocrine ward of Dalian Friendship Hospital from August 2017 to August 2018 were enrolled. The demographics, clinical data, and Activities of Daily Living (ADL) scale of each patient were recorded, and the Instrument Activities of Daily Living (IADL) and the weak score were used to record heart rate variability in each patient. Aweak score of 5 was used as boundaries. Patients with weak score greater than or equal to 5 were divided into weak group, and those less than 5 were divided into non-weak groups. Each indicators were compared between the two groups. The statistically significant variables were used as covariates, and the weak scores were used as dependent variables to perform direct and indirect Logistic regression analysis of covariates and dependent variables and the receiver operation characteristic (ROC) curve. Results: There were significant differences between the two groups in age, diabetes history, heart rate variability, standard deviation of NN intervals (SDNN), standard deviation of sinus RR interval every 5 min (SDANN), triangle index, ultralow frequency (ULF), very low frequency (VLF), activities of daily living (ADL), instrument activities of daily living (IADL) (t=13.45, U=1700, t=-17.52, t=-18.34, U =1204.00, U=3407.56, t=17.90, t=21.89, t=12.21, P< 0.05). Age, diabetes history, heart rate variability, SDNN, SDANN, triangle index, ULF, VLF, ADL, IADL were independent factors of weakness (B=1.14, 0.98, - 0.46, -0.45, -0.79, 0.57, 0.53, -0.67, -0.79, P<0.05). Age, history of diabetes, SDNN, SDANN, ULF, VLF could affect the weak score by indirectly affecting ADL/IADL (B=0.54/0.23, 0.16/0.07, -0.34/-0.04,, -0.54/-0.03, 0.99/0.21, 0.47/0.22, P< 0.05). SDNN, SDANN and ULF could significantly predict weakness, and the sensitivity values of the Yuedeng index maximum were 98ms, 97ms and 236 ms²/Hz, respectively. Conclusions Week score needs to be assessed in patients with diabetic autonomic neuropathy who have a long history of diabetes, and a DANN greater than 98 ms, a SDANN greater than 97 ms, and a ULF greater than 236 ms²/Hz in the heart rate variability index.

Objective To explore the feasibility and clinical effect of laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder.Methods Forty-one patients who underwent laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder from July 2013 to August 2019.There were 31 cases performed in Beijing Chaoyang hospital and 10 cases in National Cancer Center.Mean age was 59 (range 44-78) years,mean BMI was 25.3 (range 20.1-34.7) kg/m2,and mean CCI was 3 (range 2-6).No urethral stricture or urinary incontinence was found by preoperative examination.No distant metastasis was identified by bone scans,chest X-ray and sonography.Cystoscopy or TURBT was performed on all patients and biopsy was taken to confirm the diagnosis.Preoperative pathology showed 30 cases (73.2％) of MIBC,9 cases of NMIBC (22.0％) and 2 cases (4.9％) of in-situ cancer.Laparoscopic radical cystectomy and lymphadenectomy were performed under general anesthesia.Urinary diversion was completed in the peritoneal cavity,by intercepting the terminal ileum about 60 cm,and taking the proximal ileum 10 cm as input loop on the right side with proximal to distal way,and the middle 40 cm ileum was detubated.After u-shaped suture,the ileum was folded back and stitched into a sphere building a novd orthotopic neobladder with bilateral isoperistaltic afferent limbs.The prognosis of perioperative data and postoperative satisfaction regarding continence were analyzed,continence was defined as 0-1 pad/day.The 41 patients were divided into two groups to compare the difference in term of operation time and blood loss between the first 21 patients and the last 20 patients.Results Mean total operative time was 324.9 mins (range 210-480) mins,and mean estimated blood loss was 177.6(range 50-700) ml.There were significant statistical differences in term of total operation time,construction time and blood loss between the first 21 patients and the next 20 patients (P ＜ 0.05).Postoperative pathological results were urothelial carcinoma in 40 cases (2 in situ carcinoma) and small cell carcinoma in 1 case.Mean number of dissected lymph nodes was 19 (range 11-58),with 7 cases(17.1％)of positive lymph nodes,and 3 cases(7.3％) had positive surgical margin.At a mean follow up of 17.6 (range 2-64) months,36 patients (87.8％) survived,including 2 patients (4.9％) with metastasis and 1 patient (2.4％) with recurrence,and 5 cases (12.2％)died.All patients were able to urinate without catheterization.Thirty-seven patients (90.2％) were satisfied with voiding control during the daytime (0-1 urinal pad),and 29 patients (70.7％) were satisfied with voiding control at nighttime (0-1 urinal pad) by the follow-up 12 months after the operation.Conclusions Total laparoscopic radical cystectomy combined with Xing's orthotopic ileum neobladder is a simple method with fewer postoperative complications and a satisfactory continence rate.

Presently the four high characteristics and rejuvenation trends of cerebrovascular diseases are still the main problems that endanger the health of our people. Accordingly, Professor Gao Li has been committed to the discussion of risk factors for cerebrovascular diseases and the practice of using integration of traditional Chinese and western medicine for diagnosis and treatment of these diseases. In order to enable the majority of western medicine doctors to understand and accept his idea, Professor Gao Li combines traditional Chinese medicine (TCM) syndromes with modern etiology and pathology, classification of stages and types of cerebral infarction by Chinese and western medicine, the acute cerebral infarction patients are simplified innovatively into four TCM syndromes and appropriate treatments are given to them, so that the majority of traditional Chinese and western medicine doctors can comprehensively recognize the condition of this disease from macroscopic to microscopic points of view. By his above combination of traditional Chinese and western medicine reasoning, the patients obtained better curative effect. After multiple years of summary and accumulation of his experiences, Professor Gao Li has developed the distinct clinical and academic characteristics for the diagnosis and treatment of cerebral infarction.

Cerebral hemorrhage has been regarded as a complex and refractory disease in neuroscience due to its diversification of etiology and complexity of pathophysiology. At present, the conservative treatment of Western medicine is only symptomatic treatment. There is no specific treatment for hematoma and local circulation disorders after cerebral hemorrhage. Surgical treatment, the effect has not been significantly improved. Cerebral hemorrhage belongs to the category of apoplexy in traditional Chinese medicine, which is also called hemorrhagic apoplexy in modern Chinese medicine. Although modern Chinese medicine treatment is based on differentiation of symptoms and signs, it has no obvious advantage over western medicine treatment. After years of clinical exploration and practice, Professor Gao Li has achieved good clinical efficacy in the diagnosis and treatment of cerebral hemorrhage with integrated traditional Chinese and Western medicine, showing a good prospect of integrated traditional Chinese and Western medicine treatment.

To evaluate the relationship between atherosclerosis and hemodynamic of coronary artery in mice detecting by ultrasound bio‐microscopy flow imaging . Methods Double 14 20‐week‐old LDL‐R‐/‐and C57BL/6 male mice were selected ,and randomly divided into two groups in each genotype according to weight . Each two groups were fed to 28 weeks or 36 weeks age respectively with west diet . Coronary artery hemodynamics in these mice were assessed in vivo by Vevo ?2100 ultrasound imaging system ,then the intima‐media thickness( IM T ) of aorta in histopathology were analyzed . T he differences of coronary artery hemodynamic parameters such as maximum velocity ( Vmax ) ,mean velocity ( Vmean) and velocity time integral ( V T I) were compared between mice of different genotypes of the same week and mice of different weeks of the same genotype . And the relationship between coronary artery hemodynamic in ultrasound and aortic IM T in histopathology were analyzed . Results ① All coronary hemodynamic parameters in LDL‐R‐/‐ mice were significantly lower than those of wild‐type mice except the Vmax between two 28‐week‐old genotypes group at the same weeks of age of different genotypes ( all P ＜0 .05) . But there was no significant difference in coronary artery hemodynamic parameters between mice of the same genotype at different weeks of age( P ＞0 .05) . ②T he histopathological measurements of aortic IM T in LDL‐R‐/‐mice were significantly higher than those of wild type mice ( all P ＜ 0 .05 ) ,and those of 36‐week‐old mice were significantly higher than those of 28‐week‐old mice ( all P ＜ 0 .05 ) . ③ All coronary hemodynamic parameters such as Vmax ,Vmean and V TI were negatively correlated with pathological measurements of aortic IM T ( r ＝ －0 .532 , －0 .423 , －0 .524 ; all P ＜ 0 .05 ) . Conclusions The parameters of coronary artery hemodynamics obtained by ultrasound bio‐microscopy are well correlated with the pathological results of atherosclerosis . Ultrasound bio‐microscopic flow imaging can be used as a new method to evaluate the degree of atherosclerosis in mice by detecting the hemodynamic parameters of coronary artery .

Objective To study the effects of modified Duhuo-Jisheng decoction for treatment of paresthesia after transforaminal endoscopic discectomy in patients with lumbar disk herniation. Methods A total of 89 lumbar disk herniation patients with paresthesia after transforaminal endo-scopic discectomy were divided into the control group (n=44) and the treatment group (n=45) by random number table method. The control group were treated with mecobalamin capsule, and the treatment group treated modified Duhuo-Jisheng decoction. The two groups were treated for 4 weeks. The VAS scale was used to evaluate the pain level of the lower extremities, and the nylon rope test score was used to evaluate the numbness of the lower extremities; and the Oswestry Disability Index was used to evaluate lumbar function; and the World Health Organization Quality of Life (WHOQOL-BREF) was used to evaluate the quality of life. The clinical efficacy of the two groups was compared. Results The total effective rate was 93.3％ (42/45) in the treatment group and 75.0％ (33/44) in the control group. There were significant differences between the two groups (χ2=5.641, P<0.05). After treatment, the VAS score and ODI score in the treatment group were significantly lower than those in the control group (t=11.440, 8.976, P<0.01). The nylon rope test score and WHOQOL-BREF score were significantly higher than those of the control group (t=10.524, 6.221, P<0.01). Conclusions The modified Duhuo-Jisheng decoction can significantly improve pain and numbness of lower extremities, lumbar function and quality of life in lumbar disk herniationpatients with paresthesia after transforaminal endo-scopic discectomy.