Programmed death1-ligand(PD-L1)is a new member of B7 family,whose receptor is pro-grammed death-1(PD-1). The interaction between PD-L1 and PD-1 can down-regulate the activation of immune response. There are some differences in the expression of PD-1 and PD-L1 in normal tissues and tumor tissues, which may provide a new way for the immunotherapy of carcinoma.

Objective To study the different effects of early active mobilization on flexor ten don sheath regeneration when the sheath has bee n partially removed and when the inju red sheath has been sutured.Methods In 192Leghorns involved in this study,the zone II flexor digital profoun d tendons were partially ruptured at their bilateral 3rd digits.Their te ndon sheathes were partially removed or sutured.All the Leghorns were di vided into four groups randomly:active mo bilization-sheath removed(A 1 ),active mobilization-sheath sutur ed(A 2 ),immobilization-sheath removed(C 1 ),and immobilization-sheath suture d(C 2 ).Their toes were harvested in the1st,2nd,3rd,4th,8th and 12thweeks postoperatively.Then morphologic al observations and biomechanical tests were performed.All data were s tatistically analyzed.Results In the 1st week postoperatively,the tendon sheath structure disappeared in the injured areas in both groups of A 2 and C 2 ,while in groups of A 1 and A 2 ,neogenetic tendon sheath formed in t he operation areas.In groups of C 1 and C 2 dense scar tissues developed around the tendon without neogenesis of tendon sheath or sheath-like str ucture.There was no significant dif ference either morphologically or biomechanically between A 1 and A 2 as well as C 1 and C 2 while significant differences were found between A 1 and C 1 as well as A 2 and C 2 .Conclusions The pathologic transformation afte r sheath repair during active mobilization c an be divided into three stages:The s heath decomposed and degenerated in the1st week postoperatively.Early neogenetic sheath formed in 2weeks.The neogenetic sheath matured in 4to 8weeks.Active mobilization to promo te neogenesis of sheath is a key facto r to prevent adhesion.Only tendon sheath repair cannot prevent adhesion effectively.

Objective To screen the sensing elements for TNT detection in Escherichia coli genome.Methods A genome promoter library with cutting E.coli K-12 MG1655 genome was constructed.Bacterial luciferase luxCDABE was used as a reporter gene during promoter screening.We discovered TNT sensing elements through several rounds of screen-ing.Through analysis of sensitivity, specificity and timeliness, the promoter activity of the elements was evaluated,and the functional sequence of the elements was further confirmed.Results and Conclusion We successfully constructed an E.co-li K-12 MG1655 genome library , from which a TNT sensing element was discovered,which had a good performance in the analysis of sensitivity, specificity and timeliness.In this study, we reported that the topAp4 is a TNT sensing element for the first time.We also verified its excellent promoter activity.

Background and purpose:Tumor suppressor gene P53 has long been studied in tumors, including breast cancer. More studies focused on the relationship between P53 and prognosis of breast cancer and found that P53 overexpression suggested a bad prognosis. However, the effect of P53 on early stage postmenopausal patients with ER-positive breast cancer has not been clariifed yet. This study was to investigate the role of P53 plays in aromatase inhibitor (AI) resistance among early stage postmenopausal patients with ER-positive breast cancer patients. Methods:A total number of 293 operable breast cancer patients who received surgical treatment during Jul. 2000 to Jul. 2006 in Fudan University Shanghai Cancer Center were enrolled into this study. All patients received AI treatment. The SPSS 12.0 software was used to estimate the survival rate. Univariate and multivariate analysis were also performed via above software. Results:The median follow-up time is 72 months (6-140 months). The 5 year disease free survival (DFS) of P53 positive and negative were 78%and 89%. The results showed that P53 overexpression (HR=1.729, 95%CI:1.038-2.880, P=0.035), pathological stage (HR=2.270, 95%CI:1.399-3.681, P=0.001);histological grade (HR=2.328, 95%CI:1.312-4.133, P=0.004); age (HR=1.988, 95%CI:1.511-2.617, P<0.005) were still the independent risk factors of recurrence and metastasis in breast cancer patients treated with AI. Conclusion:P53 overexpression correlated strongly with AI resistance in early stage postmenopausal patients with ER-positive breast cancer patients who were treated with AI and conifrmed the relevance of previously described prognostic factors. It is reasonable to take P53 expression into account when we evaluate the risk of breast cancer patients and decide the anti-cancer treatment strategy.

Objective:Based on the perspective of supply and demand balance, to analyze the implementation effects of primary-feature medical services measures in medical alliances.Methods:From July to September 2019, two regions with different levels of economic development were chosen, and from each region one leading hospital and two community health service centers/township hospitals were selected from its medical alliance. A total of 213 medical staff and 703 residents were surveyed, to learn their awareness and performance appraisal of these feature services.Frequency and proportion were calculated in a descriptive statistical analysis. The scores of the performance appraisal of both supply and demand sides were tested by independent sample t. Results:In the performance appraisal of such measures, the average scoring by medical staff was 4.39±0.07, and that by residents was 3.85±0.06; the residents were more concerned with service capabilities and contents, while medical staff were more concerned with service content and delivery mode; supply and demand sides were found with consensus in terms of improving the medical service quality of chronic diseases in primary level and service accessibility.Conclusions:The county-level medical alliances should focus on enhancing their capacity of primary medical services, and improving their primary service mode with the help of medical insurance institutions. Meanwhile, it is imperative to optimize the primary medical service policy in view of supply and demand balance.

Abstract Comprehensive sexuality education is an important part of quality education, primary and secondary schools are the most suitable places for sex education. This paper sorts out the current status of sexuality education for primary and secondary school students in developed countries after presenting the overall significance of school based sexuality education, and further points out the problems and urgency of sexuality education for primary and secondary school students in China. It also put forward the way to new directions for advocacy, including the comphrehensive sexuality education curriculum system, training of sexuality education teachers, the positive and active role of families, as well as social and community support for sexuality education in schools.

Objective: To explore the clinicopathological characteristics and prognostic factors of gastric neuroendocrine neoplasm (NEN). Methods: Clinicopathological parameters and follow-up data collected from 117 patients with gastric NEN at Tianjin Medical University Cancer Institute and Hospital from March 2011 to December 2017 were reviewed, classified, and graded according to World Health Or-ganization (WHO) 2010 classification. Clinicopathological characteristics of different types and grades of gastric NEN were compared and survival analysis was performed. Results: Among the 117 cases confirmed as gastric NEN, this entire cohort comprised 13 cases (11.1%) of neuroendocrine tumor (NET) G1, 6 cases (5.1%) of NET G2, 57 cases (48.7%) of neuroendocrine carcinoma (NEC), and 41 cases (35.1%) of mixed adenoneuroendocrine carcinoma (MANEC). Gastric NET G1 and G2 typically consisted of multiple small tumors with shallow invasion and infrequent lymphatic and distant metastases at early stages at the time of diagnosis. The treatment of patients with gastric NET included endoscopic submucosal dissection and radical surgical resection. Precursor neuroendocrine lesions were detected in most cases. The patients with gastric NET G1 and G2 had a good prognosis. Gastric NEC and MANEC mostly consisted of single large tumors with deep infiltration, and common lymphatic and distant metastases at advanced stages when the diagnoses were confirmed. All the patients with gastric NEC and MANEC underwent surgical resection, and most received adjuvant therapy. Histopathological changes of gastric NEC were characterized by large cells and poorly differentiated tumors, while gastric MANEC had various forms of neuroendocrine and adenocarcinoma components. The prognosis of patients with gastric NEC and MANEC was poor for both; however, the predictors of progression-free survival and overall survival were different between gastric NEC and MANEC. Conclusions: Gastric NEN are a group of heterogeneous tumors with different clinicopathological features and prognosis. More multicenter studies with large sample sizes are still needed to improve the classification of gastric NEN and explore the prognostic factors.

Objective:To investigate the effect of ionizing radiation on the ferroptosis of skin cells and the potential therapeutic strategy of ferroptosis inhibitor Ferrostatin-1 (Fer-1) on irradiated skin cells.Methods:HaCaT cells were pre-treated with Fer-1 before X-ray irradiation. After irradiation, CCK-8 assay and LDH release assay were used to detect cell viability and cell death, flow cytometry was used to detect the lipid peroxidation levels, crystal violet staining assay was used to detect colony forming ability, and the expressions of ferroptosis related proteins ACSL4 and GPX4 were detected by Western blot.Results:The cell viability of HaCaT cells was significantly decreased ( t=5.63, 8.74, P<0.05) and the release of LDH was significantly increased ( t=3.98, 5.08, 9.27, P<0.05) after different doses of X-ray irradiation. The cell viability was improved ( t=5.79, P<0.05) and the release of LDH was reduced ( t=12.36, 11.96, 18.13, 9.96, P<0.05) after the pre-treatment with Fer-1. The lipid peroxidation levels of HaCaT cells were significantly increased ( t=9.59, P<0.05) and the clonogenic survival ability were reduced ( t=4.26, P<0.05) after 10 Gy X-ray irradiation, while Fer-1 pre-treatment reduced ( t=6.48, 17.04, P<0.05) the increase of lipid peroxidation level induced by X-ray irradiation and also effectively restore ( t=3.96, P<0.05) the clonogenic survival ability. The expressions of ACSL4 and GPX4 were decreased after 10 Gy X-ray irradiation, while they recovered to normal level ( t=5.23, 7.16, 4.78, 8.29, 6.43, P<0.05) after the pre-treatment with Fer-1. Conclusions:Ferroptosis inhibitor Fer-1 alleviates the progress of radiation-induced skin injury by inhibiting ferroptosis after ionizing radiation at the cellular level, which provides a potential strategy for the protection of radiation injury.

Objective:To investigate the efficacy and safety of the Steward Scale(S Scale)and the Modified Aldrete Scale (A Scale) for resuscitation of children undergoing gastrointestinal endoscopy with general anesthesia.Methods:A total of 199 underage children who underwent non-intubated gastrointestinal endoscopy with general anesthesia in Children′s Hospital, Zhejiang University School of Medicine from July to December 2022 were retrospectively included in this study and divided into preschool group (36 cases), low school-age group (75 cases) and high school-age group (88 cases) according to age. S Scale and A Scale were also performed to evaluate the recovery from anesthesia. The vital signs of the children and the time required for reaching the target were recorded, and the scoring efficiency and safety of the two scales were compared.Results:The time required for S Scale to reach the standard (17.50 ± 9.29) min was significantly lower than that of A Scale (20.80 ± 12.61) min, and the difference between the two groups was statistically significant ( t = 2.97, P<0.01). In the low school-age group, oxygen saturation (0.989 ± 0.010) of A Scale was higher than that of S Scale (0.980 ± 0.015), the difference was significant ( t = 2.17, P<0.05). The time required for S Scale to reach the standard was negatively correlated with age ( r = -0.385, P<0.01). There was no significant correlation between the time required for A scale to reach the standard and the children′s age ( r = -0.089, P>0.05). Conclusions:Although Steward Scale is more efficient than modified Aldrete Scale in evaluating anesthesia resuscitation in underage children undergoing gastrointestinal endoscopy with general anesthesia, modified Aldrete Scale is safer than Steward Scale and is more conducive to ensuring the life safety of children.

Objective: To evalate the effectiveness and suitability of a wearable health monitoring device for community-based management of hypertension. Methods: In December 2015, 400 patients with hypertension were enrolled from Beijing, Chaoyang. Subjects were divided into an experimental group (220 cases) and control group (180 cases), and baseline data were collected. The control group received follow-up with general planning while the experimental group received wearable health devices. Follow-up was performed three times using a questionnaire (April, August, and December 2016), and medical staff provided feedback and guidance. The experimental group was also classified according to risk factors and intervention measures were individually designed, and included monitor and medication compliance, self-management ability, and social support. Communication between patients and medical staff was recorded to form a case system. Evaluation indexes included accuracy and reliability, blood pressure management efficacy, behavior intervention efficacy, satisfaction, and disease burden. A t-test, non-parametric test, and chi-square test were used to compare the experimental and control groups before and after intervention. Results: At 1-year follow-up, after correcting for differences in baseline information between the two groups, statistically significant differences in numerical indexes were observed for number of visits within 1 month [1(1) vs. 1(1), Z=5.42], payment within 1 month [85(141) yuan vs. 40(70) yuan, Z=-2.66], visiting time [20(20) min vs. 20(15) min, Z=-2.82], exercise times [4.79(2.24) times/week vs. 4.09(2.00) times/week, Z=9.27], medication compliance score [7.33(5.77) vs. 8.70(5.24), Z=6.86], satisfaction [9.27(0.08) vs. 8.88(0.10), Z=11.77], diastolic pressure [(78.93±0.56) mmHg vs. (81.32±0.61)mmHg, F=8.70] (1 mmHg=0.133 kPa), and body mass index [(25.55±0.27) kg/m² vs. (27.74±0.43) kg/m², F=-2.24]. In addition, classification indexes adjusted for normalized blood pressure and habitus were different between experimental and control groups (χ²=3.89, 8.38, P≤0.05). The equipment worked well, with performance rates of over 90% (90.9%, 97.3%, and 92.7%). Conclusion The wearable health monitoring equipment showed good stability and reliability, and was able to effectively support health management in patients with hypertension in the community. At the same time, the equipment can improve healthy lifestyle compliance and awareness or self-management of blood pressure. In this manner, the burden of disease is reduced and the quality of life is improved.