Exosomes are membrane vesicles released into the extracellular environment upon exocytic fusion of multivesicular bodies with the cell surface. As a result of initial studies showing that exosomes display signal and immune factors,a particular interest has emerged in their use as a cellular vehicles for stimulation of immune responses in vivo.In recent years,on the base of the knowledge of the biological properties and functions, exosomes have been rebuilt and bound to different kinds of immunological stimulators as a result to enhanced antitumor funotions.In this paper,the related methods,immunological stimulators and the properties of man-made exosomes are mainly reviewed.

This paper firstly introduced concept,advantages,disadvantages,and application prospect of free indexing. Then the theoretical feasibility of applying free indexing in the images of TCM ancient literatures was discussed with the combination of their characteristics.In the end,the article made examples to illustrate the application of free indexing in related subjects.

Objective To investigate the present condition of unique copy of TCM ancient books, and analyze the literature value. Methods Bibliographic research was underwent first, then investigation table was made, investigation team for spot investigation was organized, the bibliography was sorted, and on this basis analysis of the literatures was performed. Results 59 collection units at home and abroad and 1370 unique copy TCM ancient books were investigated, which including 57 books published by photocopy and 37 books published by proof reading. Conclusion The unique copy TCM ancient books have important academic value and can be effectively saved and sorted through in-depth investigation and analysis.

Objective To explore the value of BI-RADS scoring system based on the sonographic features in the breast nodules.Methods In order to build a Logistic regression model,regression was made to analyse 401 patients ' sonographic features of breast nodules.A scoring system was developed based on the results of regression's filter and the weight of each factor,used to score and classify the other 243 patients.It's diagnostic value was evaluated through comparing all types of theoretic risk ranges of BI-RADS.Results Age,morphology,orientation,margin,echo pattern and microcalcifications in a mass were selected in the final step of the logistic regression analysis.By means of scoring system,the scores corresponding to BI-RADS 3,4a,4b,4c,5 classes are 6,7-8,9-15,16-22 and ≥23 respectively.Case study comprehensive score of BI-RADS 3-5 classification' s positive predictive values were 0,4.17％,21.43％,84.85％,1 00％,and the area under the ROC curve scoring system was 0.947.Conclusions The scoring system can objectively score and classify breast nodules,and therefore provide an effective reference for clinical evaluation of benign and malignant breast.

Objective To preserve traditional Chinese Medical (TCM)classical and also to facilitate its reading.Methods A database consisted of 10 datasets was designed on ORACLE 9i.TCM classical on health preservation and in good edition were selected from collections of the Library of China Academy of Chinese Medical Sciences for scanning,indexing,and abstracting.An online browser Was also developed for the database.Results An online database including 110 TCM classical on health preservation information Was constructed.More than 50% of books covered in the database are rare ones.Bibliographic information and keyworda Can be searched in different ways,and pictures of full text can be browsed.Conclusion Digitalization is a good way for ancient book preservation and utilization.Further effort for knowledge discovery from TCM classical should be done.

Purpose To explore the difference of expression and prognostic significance of SP1,KLF4 and p21 in low grade ovarian serous carcinoma (LGSC) and high grade ovarian serous carcinoma (HGSC).Methods The expression of SP1,KLF4 and p21 protein was examined with immunohistochemistry EliVision method in cases with LGSC and HGSC.Kaplan-Meier analysis and Cox multivariate survival analysis were used to assess the impact of SP1,KLF4 and p21 expression on prognosis of LGSC and HGSC.Results SP1,KLF4 and p21 expression were detected respectively in 74.5％,17.0％ and 11.7％ HG-SC cases,and in 65.2％,34.8％ and 26.1％ LGSC cases.Compared to control group,the expression level of SP1 was significantly higher (P ＜ 0.05),but the expression level of KLF4 and p21 were significantly lower (P ＜0.05).There was no significant difference of SP1,KLF4 and p21 expression between HGSC and LGSC (P ＞ 0.05).The expression of SP1,KLF4 and p21 were associated with FIGO stage,meanwhile SP1 associated with residual tumor size in HGSC (P ＜ 0.05).There was a significant negative correlation between SP1 and KLF4,p21 proteins in HGSC (P ＜ 0.05).Kaplan-Meier analysis revealed that there were significantly poor overall survival (OS) of 5 years for patients with HGSC displaying high expression of SP1,or low expression of KLF4 and p21 (P ＜0.05),but no significantly improved OS for patients with LGSC (P ＞ 0.05).Cox analysis showed that SP1 overexpression is an independent prognosis factor for HGSC.Conclusion Overexpression of SP1 and low expresion of KLF4 and p21 contribute to carcinogenesis of HGSC and LGSC.They are associated with a poor prognosis of HGSC,but not LGSC,meanwhile SP1 is an independant prognosis factor for HGSC.

Objective:To identify the transmission relationship between HIV infection cases the non-marital non-commercial heterosexual contact in Zhejiang Province.Methods:When HIV positive was informed during January 2020 to January 2022, the staff conducted an epidemiological investigation to collect cases information on sociodemographic characteristics, mobility information, past HIV testing history, high-risk sexual behaviors, sexual partners, and etcetera. At the same time, 6-8 ml of blood from the new diagnosis of people infected with HIV before antiviral treatment was collected to separate the bleeding plasma. pol gene was amplified by nucleic acid extraction and PCR, sequenced by Sequencer 5.0 software, and Cytoscape 3.6.0 software was used to draw HIV molecular transmission network. Results:From January 2020 to January 2022, 88 HIV infected individuals were found in Pujiang County, of which 74 were transmitted through heterosexual transmission, of which 31 were infected through non-marital non-commercial heterosexual contact. Preliminary case studies have found that three female cases have engaged in unprotected non-marital non-commercial heterosexual contact with one male case. Among the 4 infected individuals, 2 of their spouses tested positive for HIV antibodies. Molecular transmission network monitoring was carried out on 65 newly diagnosed cases of heterosexual transmission with acquired sequences, forming 9 transmission clusters. The largest cluster contained 10 cases. A total of 11 HIV-infected individuals were involved in this HIV cluster epidemic. They were 3 males and 8 females, all over 50 years old and were farmers or rural housewives. They were traced to 7 sexual partners (6 negatives of HIV, 1 undetected). Among the 18 respondents' sexual social network relationships, there were 6 couples, 8 permanent partners, and 3 temporary partners. Among 11 HIV infected individuals, there were 9 cases of non-marital non-commercial heterosexual transmission and 2 cases of intramarital transmission. The epidemiological association between 7 non-married non-commercial heterosexual partners and case 2 (56-year-old male farmer), 3 cases confirmed by epidemiological investigation and molecular transmission cluster results, 3 cases confirmed by molecular transmission cluster and epidemiological investigation results, and 1 case confirmed by epidemiological investigation results.Conclusions:The transmission mode of this cluster epidemic was to spread HIV through heterosexual sex with a male case as the core, then cause the transmission within marriage and between fixed sexual partners. The combination of epidemiological investigation and molecular transmission network traceability survey supports the conclusion of this study.

Objective To investigate the different expression and prognostic significance of forkhead box M1 ( FOXM1) and Gli?l in ovarian high grade serous carcinoma ( HGSC) . Methods The expressions of FOXM1 and Gli?1 in 94 cases of HGSC and 20 cases of normal fallopian tube tissues were detected by immunohistochemistry. Kaplan?Meier analysis and Cox multivariate survival analysis were used to assess the relationship of the FOXM1 and Gli?1 levels with age, International Federation of Gynecology and Obstetrics ( FIGO) stage, omental metastasis, and residual foci and prognosis of HGSC. Results The positive rates of FOXM1 and Gli?1 expression in HGSC were 79.8% (75/94) and 77.7% (73/94), respectively, both significantly higher than those of the normal controls ( P<0.05) . The expressions of FOXM1 and Gli?1 were significantly correlated with FIGO stage, and both of their positive rates in stage Ⅲ-Ⅳpatients were significantly higher than those in stage Ⅰ-Ⅱ cases ( P<0.001) . The expressions of FOXM1 in HGSC were positively correlated with Gli?1. Kaplan?Meier analysis revealed that the 5?year overall survival rates of FOXM1?and Gli?1?positive groups were 8.0% and 6.8%, significantly lower than 36.8% and 38.1% of the FOXM1?and Gli?1?negative groups, respectively ( P<0. 05 for both ) . Cox multivariate survival analysis revealed that FIGO stage and overexpression of FOXM1 protein were independent prognostic factors of HGSC patients ( P<0.05 for both) . Conclusions The overexpression of FOXM1 and Gli?1 proteins participate in the carcinogenesis of HGSC, and are significantly associated with FIGO stage. The protein expression of FOXM1 is positively correlated with Gli?1 in HGSC. Expression of FOXM1 protein and FIGO stage are independent prognostic factors of HGSC.

Objective To investigate the different expression and prognostic significance of forkhead box M1 ( FOXM1) and Gli?l in ovarian high grade serous carcinoma ( HGSC) . Methods The expressions of FOXM1 and Gli?1 in 94 cases of HGSC and 20 cases of normal fallopian tube tissues were detected by immunohistochemistry. Kaplan?Meier analysis and Cox multivariate survival analysis were used to assess the relationship of the FOXM1 and Gli?1 levels with age, International Federation of Gynecology and Obstetrics ( FIGO) stage, omental metastasis, and residual foci and prognosis of HGSC. Results The positive rates of FOXM1 and Gli?1 expression in HGSC were 79.8% (75/94) and 77.7% (73/94), respectively, both significantly higher than those of the normal controls ( P<0.05) . The expressions of FOXM1 and Gli?1 were significantly correlated with FIGO stage, and both of their positive rates in stage Ⅲ-Ⅳpatients were significantly higher than those in stage Ⅰ-Ⅱ cases ( P<0.001) . The expressions of FOXM1 in HGSC were positively correlated with Gli?1. Kaplan?Meier analysis revealed that the 5?year overall survival rates of FOXM1?and Gli?1?positive groups were 8.0% and 6.8%, significantly lower than 36.8% and 38.1% of the FOXM1?and Gli?1?negative groups, respectively ( P<0. 05 for both ) . Cox multivariate survival analysis revealed that FIGO stage and overexpression of FOXM1 protein were independent prognostic factors of HGSC patients ( P<0.05 for both) . Conclusions The overexpression of FOXM1 and Gli?1 proteins participate in the carcinogenesis of HGSC, and are significantly associated with FIGO stage. The protein expression of FOXM1 is positively correlated with Gli?1 in HGSC. Expression of FOXM1 protein and FIGO stage are independent prognostic factors of HGSC.

Objective To explore the clinical efficacy of prone position ventilation(PPV)in improving hypoxemia in patients with severe brain damage.Methods A retrospective research method was conducted,140 patients with severe brain damage who were admitted to the department of critical care medicine of the First Affiliated Hospital,Zhejiang University School of Medicine from August 2020 to August 2021 were selected as subject objected.According to the inclusion and exclusion criteria,20 patients with oxygenation index≤200 mmHg(1 mmHg≈0.133 kPa)who were treated with PPV were statistically analyzed.The patients'blood gas analysis related indicators[including arterial partial pressure of oxygen(PaO2),fractional of inspired oxygen(FiO2),oxygenation index,arterial oxygen saturation(SaO2),arterial partial pressure of carbon dioxide(PaCO2),pH value],ventilator-related parameters[including peak inspiratory pressure(PIP),positive end-expiratory pressure(PEEP),tidal volume(VT),lung dynamic compliance(Cdyn),etc.],and mean arterial pressure(MAP),heart rate(HR)were compared before PPV,12 hours after PPV,and 12 hours after reverting to supine position.At the same time,the related complications of patients during PPV were recorded.Results There were 15 males and 5 females,the mean age of the patients was(46.10±17.22)years old,the average PPV time was(22.20±5.94)hours.Compared with before PPV,patients showed significant increases in PaO2,oxygenation index,SaO2,VT,and Cdyn at 12 hours after PPV and 12 hours after recovery from supine position[PaO2(mmHg):98.35±21.85,98.45±17.90 vs.72.15±10.14,oxygenation index(mmHg):198.82±40.51,202.27±46.39 vs.133.20±33.95,SaO2:0.97±0.02,0.97±0.01 vs.0.94±0.03,VT(mL):558.42±111.23,580.29±119.44 vs.484.82±123.77,Cdyn(mL/cmH2O):26.11±5.42,27.90±5.80 vs.24.15±6.13,all P<0.05];Compared with 12 hours after PPV,the Cdyn of the patient still showed a significant increase after 12 hours of recovery from supine position(P<0.05).There were no statistical differences in the FiO2,PaCO2,pH value,PIP,PEEP,HR,and MAP of patients at various time points before and after PPV(all P>0.05).Five patients developed redness and swelling at the skin compression site mainly on the face after PPV,which gradually improved after returning to a supine position.During this period,there was no occurrence of catheter detachment,malignant arrhythmia,or significant hemodynamic instability.Conclusion PPV has a certain clinical effect on improving hypoxemia in patients with severe brain damage.