Objective:To study the immune stimulation effect of Portulaca oleracea L.polysaccharide ( POL-P3b) on cervical tumor-bearing mice.Methods:Using graft U14 cervical cancer mouse model ,and all the mice were randomly divided into tumor-bearing control group,cyclophosphamide (CTX) group and purslane polysaccharide low (L) (POL-P3b(L)) group and high dose of POL-P3b (POL-P3b(H)) group.After continuous treating 13 d,the thymus index and spleen index were determined; cellular immune function in mice was evaluated by ConA inducing mice spleen lymphocyte transformation test.The cytokines content of IL-2,IFN-γ,IL-10 and IL-4 secreted by spleen cells was detected using ELISA method.Indoleamine 2,3-2 oxidase ( IDO) expression in tumor tissue was detected by immunohistochemistry and Western blot method.Results:POL-P3b could obviously improve immune organ weight of tumor-bearing mice and enhance the cellular immunity function.POL-P3b could reduce the level of IL-4 and IL-10 secreted by spleen cells , and could promote the secretion of IL-2 and IFN-γ.POL-P3b also could inhibit the expression of IDO in tumor tissues ,and the effect of high dose group was more obvious.Conclusion:The antitumor mechanism of POL-P3b might be related to increase the body′s immune function and reduce the immune escape.

Objective To evaluate the effect of hypoxic-ischemic time on reduction of hypoxic-ischemic brain injury by sevoflurane postconditioning in neonatal rats.Methods Two hundred and ten 7-day-old Sprague-Dawley rats (105 male,105 female),weighing 13-17 g,were randomly divided into 7groups (n=30 each) using a random number table:sham operation group (group Sham),hypoxia-ischemia group (group HI),and sevoflurane postconditioning at different hypoxic-ischemic time point groups (P0,P3,P6,P 12 and P24 groups).Immediately after ligation of the left common carotid artery,and at 3,6,12 and 24 h after ligation,the rats inhaled the mixed gas containing 2％ sevoflurane for 30 min in P0,P3,P6,P13 and P24 groups,respectively.The fatality was recorded within 7 days after establishment of the model.At 7 days after establishment of the model,the rats were sacrificed,the brains were removed,and the right and left cerebral hemispheres were weighed separately,and the left/right cerebral hemisphere weight ratio was calculated.The hippocampal CA1 region and posterior cingulate gyrus were isolated,and the ratio of density of normal neurons in the left to the right was calculated.Results Compared with group Sham,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly decreased,and the fatality rate was increased in the other six groups (P＜0.05).Compared with group HI,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal ncurons were significantly increased in P0,P3 and P6 groups (P＜0.05),and no significant change was found in the parameters mentioned above in P12 and P24 groups (P＞0.05).Compared with group P6,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly increased in P0 and P3 groups (P＜ 0.05).There was no significant difference in the parameters mentioned above between group P0 and group P3 (P＞0.05).Conclusion Sevoflurane postconditioning performed within 6 h of hypoxia-ischemia can reduce hypoxic-ischemic brain injury,and it provides no cerebral protection if exceeding 12 h.

Diabetic ketoacidosis ( DKA ) is one of the common endocrine emergencies. With the development and applications of new drugs, the inducing causes of DKA become more and more complicated. We as clinicians should quickly and accurately evaluute the severity of DKA, and administrate reasonable rehydration and hypoglycemic treatment. What we should do better is searching the causes of DKA and help patients reasonably avoid its occurrence. In this article, two cases from clinical practice are analyzed.

Six patients(3 male,3 female)aged 33-66 yr, Course of disease 6-35 days, diagnosed with spontaneous intracranial hypotemion in Sir Run Run Shaw Hospital from November 2007 to May 2008,Were treated with on epidural autologus blood patch trader X-ray guidance. According to the results of CT myelography. the puncture site Was chosen in the 1-2 vertebral interspaees below the site of a single eerebrospinal fluid leak. For patients with multiple cerebrospinal fluid leaks.the procedure was performed at the spinal cord segment of the most severe leak. The mixture of augous blood and Omnipaque(300g/100 ml)at a ratio of 2:1 was injected into the epidural space to cover the spinal cord segment of the leaks under C-arm fluoroscopic guidance.Side effects were recorded during and after the injection of autologus blood.The treatment was repeated one week later if the former one failed.One patient was treated with epidural blood patch 3 times.and the rest 5 patients were treated with epidural blood patch 1 time.During the injeetion of autologus blood,5 patients complained of pain in the purtclure site,2 experienced pain radiating to the upper limb,2 felt,numbness in the right leg and all of these syndromes could be self-relieved.No side effects were observed after the injection of autologus blood.All the patients were Cured and no recurrence was observed during a 2-6 month follow-up.

Objective:To analyze the commonalities and differences of " Internet plus healthcare" related policies in the eastern, central and western regions of China before and after the COVID-19 pandemic and to provide references for further improving China′s " Internet plus healthcare" policy.Methods:Collecting the policies of " Internet plus healthcare" promulgated by 31 provinces(autonomous regions, municipalities)in China from April 2018 to December 2020 on the websites of various government departments, extracting keywords based on content analysis methods, and calculating degree centralities using UCINET 6 software. A comparison of the policies of the eastern, central and western regions between the pre epidemic stage(April 2018 to December 2019)and the COVID-19 pandemic stage(January 2020 to December 2020)was carried out.Results:In the pre epidemic stage, Internet diagnosis and treatment, " Internet plus medical service price" and quality supervision were the focus of attention in all regions. But the eastern region paid more attention to the policy planning of Internet hospital operation and Internet medical application, the central region focused on the transformation and efficiency improvement of medical service process by Internet technology, and the western region paid more attention to encourage the application of telemedicine to solve the difficulty of seeing a doctor. In the pandemic stage, the " Internet plus service price" was the policy focus in all regions, mostly in medical insurance payment, and the policy difference was not obvious among the eastern, central and western regions.Conclusions:Before and after the COVID-19 pandemic, the policy of " Internet plus healthcare " promulgated by the local governments in eastern, central and western regions had different emphasis and different characteristics. Our suggestion was to improve the policy system, standardize industry supervision, strengthen information security, orderly interconnect medical insurance, and actively promote the exchange of policy experiences among the provinces.

BACKGROUND: With the advancement of science and technology, invisible aligner without brackets have emerged. However, this new type of digital orthodontic technology is rarely reported on its biomechanics. OBJECTIVE: By the use of rectangular attachments of different sizes and different bonding positions, to obtain different force of canines and the stress supporting of periodontal tissue during the extrusion movement, providing reference for the clinical use of rectangular attachment in the orthodontic treatment of low canine tooth. METHODS: A three-dimensional finite element model of appliance-attachments-canine-periodontium-cancellous bone-cortical bone was established based on the scan data of the isolated canine. The attachments were set in different directions (vertical, horizontal), sizes (3, 4, 5 mm in height) and positions (in the occlusal side of the crown center, in the gingival side of the crown center). The 0.25-mm forced occlusal displacement was loaded to observe the deformation and equivalent stress of the tooth and periodontal membrane. RESULTS AND CONCLUSION: (1) If the size of rectangular attachment increases, the force of the tooth will grow in a certain range and the tooth will have better effect of extrusion with a larger level of tilt motion in other directions. (2) The extrusion effect of the horizontal attachment is better than that of the vertical attachment, which is more difficult to have distal incline, but is prone to lingual incline.

Objective:To select and extract the evidence of delivery mode decision making among repregnancy women with post cesarean section, and summarize the best evidence.Methods:Evidence-based nursing was used to retrieve the evidences on delivery mode decision making among repregnancy women with post cesarean section in the Chinese Guidelines Network, Guidelines International Network (GIN) , National Institute for Health and Clinical Excellence (NICE) , American GuidelineClearinghouse (NGC) , Joanna Briggs Institute Evidence-based Health Care Center of Australia, UpToDate, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) , WanFang data, Chinese Biological Medicine (CBM) and Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (Embase) . The evidences included the guidelines, systematic reviews, evidence summaries, recommended practices, best clinical practice information booklets and primary studies.The retrieval time was from the establishment of the database to 1st May 2019.Results:A total of 13 evidences were included, six guideline, one expert consensus and six systematic reviews, which involved 15 best evidences in four aspects, trial of labor after cesarean section (TOLAC) /vaginal birth after cesarean (VBAC) population, VBAC/uterine rupture influencing factors, delivery mode management and the delivery decision making tools.Conclusions:Evidences of clinical practice should be recommended according to the resource of medical institutions, promotion and barrier factors when medical staff apply evidences, reasonable judgments of clinician, clinical data provided by delivery women, will of delivery women and their family members. Users should continuously update evidences since the best evidences update over time to solve the problems of delivery mode decision making among repregnancy women with post cesarean section by scientific method so as to improve the nursing quality.

Objective To evaluate the clinical effect of arthroscopic treatment of femoroacetabular impingement syndrome(FAI) for patients over 50 years old,and explore the occurrence regularity and treating rules for such a disease.Methods The clinical data of 71 patients(78 hips with FAI) over 50 years old who underwent arthroscopic treatment for FAI in our department between May 2012 and May 2017 were studied retrospectively.Physical examination,X-ray and CT 3D scans were made preoperatively for explicit diagnosis.The follow-up period ranged from 6 to 66 months,with an average of 31.78 ± 18.07 months.Every patient had a joint space greater than 2 mm,and a grade Ⅰ or Ⅱ hip osteoarthrosis according to the Trnnis scale.Under the hip arthroscopy the synovial hyperplasia was cleaned,the damaged labrum and cartilage were repaired,and the femoroacetabular hyperplasia and the impingement factors were removed to restore the normal shape of femoroacetabular.The joint clearance,changes ofthe alpha angle when at Dunn position and centre edge(CE) angle at normotopia on the X-ray,the intraoperative injuries of cartilages and glenoid labrum and surgical satisfaction and complications were measured and recorded.The modified Harris hip score(mHHS) and visual analogue scale(VAS) were used to evaluate the hip function recovery and pain relief of patients.Results The average age of the patients was 55.15 ± 5.02 years old,ranging from 50 to 69.Among the 23 males and 48 females,there were 33 left hips with FAI and 45 right hips with FAI.The average preoperative joint clearance was 4.81 ± 0.87 mm,and all incisions were healed by first intention after the treatment.The average α angle of the patients decreased from 50.11 ± 4.75 to 42.72 ± 4.7 degrees after the treatment,with the α angle of 7 patients(8.97％) bigger than 55 degree,and that of 40 patients(51.28％) smaller than 50 degree.The average CE angle decreased from 36.54 ± 9.14 degrees to 35.19 ± 8.55 degrees after the treatment,with that of 27 patients(34.62％) bigger than 40 degrees.Before the treatment,the main clinical manifestations were hip pain and swelling,including 36 cases(46.15％) with hip joint lock,70 (89.74％) with groin tenderness.Moreover,75 cases(96.15％) were positive in hip adduction internal rotation test(FADIR) and 64 cases(83.33％) were positive in the hip abduction and external rotation impingement test.However,the pain was relieved or disappeared after the treatment.The average VAS score decreased significantly from preoperative 4.42 ± 1.42 points to 1.31 ± 1.28 at the last follow-up,while the average mHHS score increased significantly from preoperative(52.4 ± 19.38) points to(81.72 ± 10.82) during the last follow-up,and the difference was statistically significant (P＜0.01).Significant improvement was observed in the mHHs and VAS scores of 89％ patients(P＜0.01).1 patient(1.28％) underwent hip replacement during the follow-up period.No serious complications occurred.Conclusion In most cases,arthroscopic treatment of FAI in old patients(over 50 years old),who were with osteoarthrosis and hip labrum injury,can significantly improve the joint function and relieve pain.It is a treatment with safety.

Hevin is one of the extracellular matrix proteins secreted by astrocytes. Under physiological conditions, Hevin plays an important role in synaptogenesis in the central nervous system (CNS); secreted protein, acidic and rich in cysteine (SPARC) is its homologue and antagonizes the synaptogenic effects of Hevin. In pathological conditions, the expressions of Hevin and SPARC are altered, suggesting their possible roles at synaptic reorganization in various disease process, such as brain injury, Alzheimer's disease, epilepsy and brain tumors; however, the specific mechanism is not totally understood yet. So this paper reviews the mechanism of Hevin/SPARC in CNS synaptogenesis, reorganization and diseases to provide ideas for further research.

Objective:To predict lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer based on preoperative inflammatory and immune nutritional indicators,and to construct a nomo-gram prediction model,providing a basis and tool for preoperative diagnosis of lymph node metastasis in cervical cancer.Methods:A retrospective analysis was conducted on the clinical data of 307 patients preoperatively diag-nosed with early-stage cervical cancer who underwent surgical treatment at the Obstetrics and Gynecology De-partment of the Second Affiliated Hospital of Zhengzhou University from January 2018 to July 2023.R software was used to randomize the groups into a training set(n=231)and a validation set(n=76)in a 3∶1 ratio.Uni-variate and multivariate logistic regression analyses were employed to identify factors influencing lymph node me-tastasis in patients preoperatively diagnosed with early-stage cervical cancer.R software was used to establish a nomogram prediction model and draw receiver operating characteristic(ROC)curves and calibration curves for validation.Results:① The results of univariate logistic regression analysis showed that positive lymphovascular invasion,platelet-to-lymphocyte ratio(PLR)≥151.70,neutrophil-to-white blood cell ratio(NWR)≥0.65,plate-let-to-albumin ratio(PAR)≥ 4.94,preoperative systemic immune-inflammation index(SII)≥604.03,and sys-temic inflammatory response index(SIRI)≥ 1.05 were associated with lymph node metastasis(P＜0.05).②Multivariate logistic regression analysis found that positive lymphovascular invasion,NWR≥0.65,and PAR≥4.94 were independent risk factors for lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer(OR＞1,P＜0.05).③ A nomogram was constructed to predict lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer.The ROC curve shows an area under the train-ing set curve(AUC)of 0.821 and a validation set AUC of 0.858.The calibration curve shows an average abso-lute error of 0.024 for the training set and 0.059 for the validation set.Conclusions:The prediction model for lymph node metastasis in cervical cancer constructed using preoperative inflammatory and immune nutritional indi-cators such as NWR,PAR is helpful for gynecological oncologists to predict lymph node metastasis in cervical cancer patients before surgery.