Objective To evaluate the application value of elastic index difference (EID) in identifying benign or malignancy masses of breast imaging reporting and data system (BI-RADS) 3-5.Methods Data of 193 lesions in 164 patients with ultrasonic diagnosed as BI-RADS 3-5 breast masses were retrospectively analyzed.All the cases were confirmed pathologically.The EID of masses and normal glands were measured with elastography quantitative analysis software.BIRADS 3-5 breast masses were diagnosed as malignant when EID≥2.5,which was the criteria for BI-RADS reclassification.ROC curve was drawn,and the area under the curve (AUC) was calculated.The diagnostic accuracy and AUC of malignant breast tumors with the methods of BI-RADS and BI-RADS combined with EID were compared.Results Taking pathological results as gold standard,the sensitivity,specificity,accuracy of BI-RADS in detecting malignant tumors were 96.00％ (72/75),67.80％ (80/118),78.76％ (152/193),and those of BI-RADS combined with EID were 97.33％ (73/ 75),83.05％ (98/118),88.60％ (171/193),respectively.The AUC of BI-RADS combined with EID (0.931) was higher than that of BI-RADS (0.875;Z=2.06,P＜0.05).The statistical difference of accuracy was found between BI-RADS and BI-RADS combined with EID methods (x2 =15.21,P＜0.05).Conclusion The combination of BI-RADS and EID is better than simple using BI-RADS in identifying benign or malignancy of breast tumors.

AIM: To study the surgery method, risk factors and prevention of extracapsular cataract extraction(ECCE)and posterior chamber intraocular lens(PC-IOL)implantation through microcoria in leprosy patients in order to minimize the surgical complications.

METHODS: Totally 72 leprosy patients(83 eyes)with cataract were treated by cutting the sphincter muscle of pupil to enlarger the pupil, then performing ECCE and PC-IOL. The visual acuity and complications were retrospectively analyzed.

RESULTS: At 6mo postoperatively, best corrected visual acuity was ≥0.5 in 20 eyes(24%), 0.1 to<0.5 in 33 eyes(40%), <0.1 in 14 eyes(17%), no change in 16 eyes(19%). The postoperative complications: uveitis in 26 eyes(31%), posterior capsular rupture in 14 eyes(17%), posterior capsular opacification in 21 eyes(25%), secondary glaucoma accounted in 13 eye(16%).

CONCLUSION: Because of long course, lepra reaction and persistent iritis, the leprosy patients are suffered from nerve damage and atretopsia, which make the surgery hard to complan, the complications increased, and the postoperative visual acuity is poor.

Objective:To investigate the immunogenicity of SARS-CoV N DNA vaccine and the feasibility of live-attenuated Salmonella typhimurium as the carrier to deliver the N DNA vaccine.Method:The recombinant attenuated salmonella strain CS022 harboring the pcDNA-N DNA vaccine was constructed.And mouse was immunized with the recombinant strain via intranasal and oral routes.Cellular and humoral immune responses were assessed by ELISA,lymphocyte proliferation assays,ELISPOT and FACS.Result:The oral immunization with the transformed salmonellae elicited strong immune responses mainly including high level of N-specific antibody,a dramatic activation of IFN-?-secreting cells,a high level of lymphocyte proliferation,and a high level of activated CD8+ T cells.Conclusion:Live-attenuated Salmonella typhimurium could effectively deliver the SARS-CoV N DNA vaccine in vivo.These encouraging pre-clinical data provide a rational basis for undertaking a new immune style to investigate SARS vaccine.

Resistance of tumor cells is a complex biological process involving multiple mechanisms and factors, in which anti-apoptosis is the most important cause of drug resistance. Previous studies have shown that the DNA binding activity of Runt related transcription factor 3 (RUNX3) increased prominently in Herceptin resistant gastric cancer cells (NCI N87R) while the relevance of which to drug resistance has not yet been confirmed. In this study, we employed CRISPR/Cas9 to establish RUNX3 knock-out cell line (△RUNX3/NCI N87R) to investigate the functions of RUNX3 in Herceptin resistance of NCI N87R cells and its potential mechanisms. We investigated proteomics profiling of △RUNX3/NCI N87R cells based on label free quantitative proteomics. Differentially expressed proteins were screened out according to fold change and significance level between △RUNX3/NCI N87R and NCI N87R cells. Pathway enrichment analysis was done using GeneAnalytics database, and gene ontology analysis was conducted by DAVID Bioinformatics Resources database. Protein-protein interaction networks were constructed based on STRING database. The results showed that △RUNX3/NCI N87R cells increased the sensitivity to Herceptin. Proteomic data demonstrated that the expression of 577 genes changed significantly in △RUNX3/NCI N87R cells, among which 191 genes were up-regulated while 386 ones down-regulated comparing with NCI N87R cells. Pathway analysis showed that autophagy, cell cycle, apoptosis, mitochondrial fatty acid β oxidation, neurogenic locus notch homolog protein 1 (NOTCH1), mammalian target of rapamycin (mTOR), Hedgehog and DNA damage response pathways exhibited notable changes based on pathway enrichment ratio and significance level (P < 0.05). These results indicated that RUNX3 knock-out altered multiple signaling pathways of NCI N87R cells. Western blotting manifested that the expression of autophagy regulatory molecules autophagy-related protein (ATG) 13, 7 and BECN1 increased remarkably while cell cycle molecules serine/threonine-protein kinase Chk2 (CHEK2) and apoptosis regulator Bcl-2 (BCL2) decreased prominently in △RUNX3/NCI N87R cells. The p-AKT expression decreased significantly in △RUNX3/NCI N87R cells compared with NCI N87R cells (P < 0.01) and was suppressed by Herceptin. These results indicated that RUNX3 knock-out altered cell cycle, increased inhibition to p-AKT by Herceptin, promoted autophagy and induced cell apoptosis of NCI N87R cells. These results suggested that RUNX3 may be a potential therapeutic target for reversing or reducing Herceptin resistance in gastric cancer cells.

OBJECTIVE： To establish a method for content determination of total polyphenols from Gastrodia elata， and to optimize the purification technology of macroporous resin. METHODS： The content of total polyphenols from G. elata was determined by Folin-ciocaileu colorimetry. Using the absorption and desorption performance as index， 4 kinds of macroporous adsorption resins were selected by static adsorption and desorption tests. The flow rate and mass concentration of the sampling solution， volume fraction of eluent， eluent flow rate and eluent volume were investigated by dynamic adsorption and desorption tests. The purification technology of macroporous resin was optimized. RESULTS： The linear range of gallic acid was 4-32 μg/mL （r＝0.999 9）. RSDs of precision， stability and repeatability tests were all less than 2％. The recovery rate of the sample was 95.51％-102.94％（RSD＝2.54％，n＝6）. D301 macroporous resin had strong static adsorption and desorption ability from G. elata polyphenols. The optimal purification technology included that the sample solution flow rate 2 BV/h； the sample solution mass concentration 4 mg/mL； the elution solvent 70％ ethanol； the elution flow rate was 3 BV/h， and the eluent volume 5 BV. The content of total polyphenols from G. elata optimized by the optimal purification technology was 0.381 mg/g. CONCLUSIONS： Established method is sensitive and stable. The optimized purification technology is stable and feasible.

Intracorporeal classic gastrointestinal anastomosis using circular stapler in totally laparoscopic gastrectomy (TLG) for gastric cancer requires intracorporeal anvil placement and suitable access for introduction of the circular stapler to the abdominal cavity without gas leak. The novel techniques for anvil placement have been updated, but there is no progress for proper access for circular stapler. In the study, intracorporeal circular-stapled gastrointestinal anastomosis were successfully accomplished using a novel device of sealed cap access with a central hole (WLB-60/70-60/100, Wuhan Widerep Medical Instrument Co.,Ltd, China) customized to the incision protection retractor for the simple and accessible introduction of the circular stapler and anvil under the optimal maintenance of pneumoperitoneum pressure in TLG. In these 3 cases, there was no gas leakage and the pneumoperitoneum was well maintained when performing the gastrointestinal anastomosis, and there was no transition to laparotomy or other anastomosis techniques. The result suggests that the sealed cap access could be a novel choice for introduction of the circular stapler to the abdominal cavity in order to obtain laparoscopic circular-stapled gastroin-testinal anastomosis in TLG.
Anastomosis, Surgical ; China ; Gastrectomy ; Humans ; Laparoscopy ; Stomach Neoplasms/surgery* ; Surgical Stapling

【Objective】 To explore the relationship between plasma adiponectin levels and hypertension based on the Hanzhong adolescent hypertension cohort. 【Methods】 A total of 361 young individuals with normal renal function， aged 32 to 41 years old， were taken as the research subjects. We collected or measured data including general characteristics， blood pressure （BP）， height， weight， pulse rate， and biochemistry indexes such as fasting glucose， blood lipid and plasma hs-CRP. The concentration of plasma adiponectin was determined by ELISA method. Binary logistic regression was performed to analyze the relationship between plasma adiponectin and hypertension. 【Results】 The plasma adiponectin level in patients with hypertension was significantly lower than that in normotensive patients ［3.56 （2.57-5.02）） μg/mL vs. 4.82 （3.19-6.89） μg/mL， P=0.012］. Partial correlation analysis showed a weak correlation of plasma adiponectin level with systolic BP and diastolic BP （r=-0.155， P=0.003 and r=-0.144， P=0.006）. Binary logistic regression analysis showed that after adjusting for confounding factors such as age， BMI， and high-sensitivity C-reactive protein， the risk of hypertension was 2.46 times higher in patients with plasma adiponectin in the lowest gender-specific tertile than those in the highest tertile （OR=2.46， 95% CI: 1.22-4.99）. 【Conclusion】 Hypoaponectinemia is an independent risk factor for hypertension in young individuals with normal renal function.

Rapid and living guidelines are those developed in response to public health emergencies in a short period of time using a scientific and standardized approach. Subsequently， they provide timely and credible recommendations for decision makers through regular and frequent updates of clinical evidence and recommendations. In this paper， we introduced the definition of rapid and living guideline as well as analyzed the basic characteristics of eight rapid and living guidelines in the field of traditional Chinese medicine （TCM） published till 2023 June， summarizing three core methodological issues in relation to how to rapidly develop guidelines， how to formulate recommendations when there is lack of evidence， and how to ensure the timeliness of guidelines. Based on the analysis of current rapid and living guidelines， it is implicated that there is necessity to carry out rapid and living guideline in the field of TCM， and the methodology of rapid integration of multivariate evidence in the field of TCM needs to be further explored； furthermore， it is necessary to further explore the obstacles of implementation of guidelines and promote timely updating， all of which provide certain theoretical references for relevant guideline developers and researchers.

It is necessary to develop rapid and living guidelines in order to improve the evidence translation and guidance for clinical practice in emergency situations， and to enhance the participation of traditional Chinese medicine （TCM） in management of emergencies. This paper introduced the process of developing rapid and living guidelines of TCM and divided it into three stages， that is preparation， rapid development and dynamic updating， which highlights the features of rapid development， high quality， and dynamic updating and the integration with the predominance of TCM. By comparing with general guidelines on composition， personnel number， timing to formulate and communication patterns of the guideline working groups， as well as the content and number of clinical questions， this paper mainly gave suggestions on how to formulate a concise but authoritative team during the preparation stage， how to efficiently manage the guideline team and promote the development process from conflict of interest management， working and communication mode adjustment， and how to formulate and update the important and prioritized clinical questions， all of which may provide reference for the development of TCM rapid and living guidelines.

italic>Tussilago farfara L. is a perennial herb of Tussilago genus in the Compositae family. Its dried buds and leaves have good biological activities and have a long history of medicinal use in China and Europe. In this paper, we investigated the whole chloroplast genome characteristics, sequence duplication, structural variation and phylogeny of the Tussilago farfara L. After sequencing the Tussilago farfara L. chloroplast genome using Illumination technology, the complete Tussilago farfara L. chloroplast genome was further obtained by assembly and annotation, followed by a series of inverted repeat-large single copy/small single copy region contraction and expansion analysis, genome sequence variation, etc. The sequences of 13 homologous plants downloaded from NCBI were used to construct a neighbor-joining phylogenetic tree. The results showed that the total GC content of the chloroplast genome was 37.4% and the length was 150 300 bp; 125 genes were annotated, including 82 protein-coding genes, 35 tRNAs and 8 rRNAs; 148 (simple sequence repeats, SSR) loci were detected, and the relative synonymous codon usage showed that 31 codons out of 64 codons had a usage of >1. In the phylogenetic analysis, the chloroplast genomes of the seven species of Asteraceae, including the Yulin Tussilago farfara L., were highly conserved, and the sequence variation of the (large single-copy, LSC) and (small single-copy, SSC) regions was higher than that of the (inverted repeat, IR) region. This is in general agreement with the reported phylogeny of Yulin Tussilago farfara L. In this study, we obtained a high quality chloroplast genome and analyzed its genome characteristics, codon preference, SSR characteristics, SC/IR boundary, sequence variation and phylogeny, which can provide a basis for species identification, genetic diversity analysis and resource development of this medicinal plant.