We integrate the precision medicine into the training process of breast surgery postgraduates. Besides the traditional training, we emphasize the idea of precision medicine and provide precision medicine lessons. We also carry out multidisciplinary precision-medicine teaching ward-rounds, and take use of AI system to assist clinical decision making, so as to stimulate the subjective initiative of the postgraduates, and strengthen the training of clinical practical capabilities. Our experience has showed that applying the precision medicine mode to the training of breast surgery postgraduates is more conducive to strengthening their clinical capabilities and overall quality.

OBJECTIVE:To study the mechanism of Aurantii fructus immaturus(AFI)and its main active ingredients in pro-moting gastrointestinal motility of model rats with spleen deficiency. METHODS:170 rats were randomly divided into blank group (10 rats) and modeling group (160 rats),rats in modeling group was induced models with spleen deficiency by bitter cold diar-rhea+irregular diet. After modeling, rats were randomly divided into model group, naringin (NA) low-dose, medium-lose, high-dose groups(3.267,6.535,13.070 mg/mL),neohesperidin(NE)low-dose,medium-lose,high-dose groups(3.865,7.730, 15.460 mg/mL),synephrine(SY)low-dose,medium-lose,high-dose groups(0.252,0.504,1.008 mg/mL),compatibility groups with 3 monomer ingredients (NA-NE-SY) low-dose,medium-lose,high-dose and AFI water decoction low-dose,medium-lose, high-dose groups(0.104,0.208,0.416 g/mL,calculated by crude drug),ig,once a day,10 mL/kg,for 7 d. After the last admin-istration,gastrin (GAS) in serum,and acetylcholine (ACh),motilin (MTL),substance P (SP),vasoactive intestinal peptide (VIP)levels in plasma were detected. RESULTS:Compared with blank group,GAS level in serum and ACh,MTL,SP levels in plasma in model group were reduced(P<0.01),VIP level in plasma was increased(P<0.05). Compared with model group,ex-cept for the GAS level in serum showed no obvious change in NA high-dose group and SY doses groups,other medicine groups were obviously increased (P<0.05 or P<0.01);the ACh levels in serum were obviouly increased in NE high-dose group,SY high-dose group and AFI water decoction low-dose group(P<0.01). MTL levels in plasma were obviously increased in NE medi-um-dose,high-dose groups,SY high-dose group,compatibility low-dose,medium-dose groups and AFI water decoction medi-um-dose,high-lose groups (P<0.05);SP levels in plasma were obviously increased in NA low-dose,medium-dose groups and NE doses groups(P<0.05 or P<0.01);VIP levels were reduced in NA low-dose group,SY high-dose group and AFI water decoc-tion low-dose,medium-lose groups(P<0.05). CONCLUSIONS:AFI may promote the gastrointestinal motility of model rats with spleen deficiency by promoting the secretion of GAS,ACh,MTL,and inhibiting the secretion of VIP;there are differences be-tween AFI and the 3 monomer ingredients in regulation of gastrointestinal hormones.

BACKGROUND: Previous studies found that C57BL/6 mouse was susceptible to atherosclerosis, while BALB/c mouse was resistant to atherosclerosis. The stenosis of the culprit vessel and the severity of myocardial infarction were correlated to the levels of OX40L expression. Whether OX40L has differential expression between C57BL/6 and BALB/c mouse was not identified.OBJECTIVE: To observe the differential expression of OX40L mRNA and protein in C57BL/6 and BALB/c mouse.METHODS: Total RNA and protein were extracted by Trizol and RIPA Buffer from heart, brain, kidney, skeletal muscle and spleen tissues of C57BL/6 and BALB/c mice. RT-PCR and Western Blot were used to detect OX40L mRNA and protein expression in heart, brain, kidney, spleen and skeletal muscle of two kinds of mice. The differential expression of OX40L mRNA and protein between C57BL/6 and BALB/c mice was observed.RESULTS AND CONCLUSION: RT-PCR results showed that the mRNA expression level of OX40L in heart of C57BL/6 mice mouse was significantly higher than BALB/c mice (P ＜ 0.05); the mRNA expression level of OX40L in spleen of BALB/c mice was significantly higher than C57BL/6 mice (P ＜ 0.05). There were no significant differences in the brain, kidney and skeletal muscle between these two strains. The results of Western Blot showed that the protein expression level of OX40L in heart, brain and kidney of C57BL/6 mice were significantly higher than BALB/c mice (P ＜ 0.05). There were no significant differences in skeletal muscle and spleen between these two strains. The OX40L mRNA transcription level in heart was higher in C57BL/6 mouse than BALB/c mouse, while the expression in spleen was lower than the latter. The OX40L protein levels in C57BL/6 mouse heart, brainand kidney were higher than BALB/c mouse. The differences of OX40L expression between the two strains of mice indicated that OX40L may promote to C57BL/6 mouse susceptible to atherosclerosis.

Objective To compare and analyze the differences in CD8+naive,effector,memory,exhausted and regulatory T cells in order to investigate the impact of gender on the differentiation fate of CD8+T cells in the context of type 1 diabetes (T1D)based on female and male non-obese diabetic (NOD)mice and healthy Institute for Cancer Research (ICR)mice.Methods The frequencies and phenotypes of CD8+T cell differentiation subsets including naive T cells (TN),central memory T cells (TCM),effector T cells(TEFF),effector precursor T cells (TEP),exhausted T cells (TEX),precursor exhausted T cells (TPEX)and regulatory T cells (Tregs)in the spleen,pancreatic draining lymph nodes (pLN)and pancreas infiltrating lymphocytes (PIL)of male and female NOD mice were detected by flow cytometry.Results The frequencies of IFN-γ+,CD107a+and CCL5+CD8+TEFF in pLN and PIL of female NOD mice were significantly higher than those of male NOD mice.However,the frequencies of CD8+TN,CD8+TCM,CD8+TEX,CD8+TPEX and CD122+CD8+Tregs subsets in the spleen were significantly decreased.While there were no significant differences in the above CD8+T cell subsets except CD8+Tregs between female and male ICR mice. Conclusion Androgen may inhibit the differentiation of memory T cells into effector T cells and promote the exhaustion of effector T cells,leading to the difference in morbidity between the male and female mice.

ObjectiveTo investigate the level of hepatitis B surface antibody (anti-HBs) among preschool children (aged 3‒6 years) and primary and secondary school students in Tonglu County, Zhejiang Province, to evaluate the effectiveness of hepatitis B vaccination, and to provide a basis for hepatitis B prevention and control in the region. MethodsAs part of the 2023 Tonglu County Urban and Rural Residents Health Examination Program, blood samples were collected during health check-ups. Fingertip blood samples were obtained from preschool children, while venous blood samples were collected from primary and secondary school children. The anti-HBs levels in blood (positive + / negative -) were qualitatively tested using hepatitis B surface antibody test kits (latex method). The differences in anti-HBs positivity rates among different age groups were analyzed. ResultsBetween April 1, 2023 and June 30, 2023, a total of 52 919 individuals were surveyed, including 11 973 preschool children and 40 946 primary and secondary school students. The overall anti-HBs positivity rate was 39.74%, with the highest positivity rate observed among preschool children (60.20%). Age was negatively correlated with the anti-HBs positivity rate (P<0.001). No significant gender differences in anti-HBs positivity rates were observed. The anti-HBs positive rate in rural areas was higher than that in urban areas, with statistically significant differences across school grade groups (primary grades 1‒3, grades 4‒6, middle school, and high school) (P<0.001). ConclusionThe anti-HBs positivity rate among preschool and school-age children in Tonglu County decreases with age and remains relatively low. It is recommended to strengthen the monitoring of hepatitis B antibody levels and promote health education among preschool and school-age children. Children who have not completed the full hepatitis B vaccination should receive timely catch-up vaccination.

Objective: To explore the real experience of functional exercise after PICC operation. Methods: Phenomenological methods were used to conduct semi-structured interviews with 15 patients who had different functional exercises after PICC. Colaizzi phenomenological analysis was used to analyze the data. Results: Through interviews, four themes were drawn: the exercise characteristics of different postoperative functional exercise, the benefits of postoperative functional exercise, the obstacles to postoperative functional exercise and the suggestions for education related to postoperative functional exercise. Conclusion The patients with PICC think that the postoperative functional exercise is safe and practical, but the recognition and compliance of the postoperative functional exercise are still limited. It is suggested that appropriate training should be carried out among medical staff, so as to rationally select the way of postoperative functional exercise, further promote the application of postoperative functional exercise, and improve the compliance and experience of patients.