The data of autism in online question and answer communities of Zhidao.baidu.com and Yahoo!Answers were analyzed, which showed that the understanding of online question and answer communities users in China and USA was quite different.The users in USA mastered the basic knowledge of diseases much better than those in China and more detailed questions were asked by users in USA than by those in China.The clarity, completeness, accuracy and operability are the most important factors for selection of answers.Autism and its countermeasures have been well and widely accepted in American society.

Objective To construct the genetic engineered cell line which can continuously secrete human tumor necrosis factor ( hTNFα) in Chinese Hamster Ovary cells( CHO cells) ,and observe the change of its protein secretion function.Methods Constructed plas-mid which carries hTNFαgene expression through vector GV141.Selected stable transfection cell lines by G418 and transfection with lipo-fectamine.Identified its gene expression with Real-Time PCR,and identified its protein secretion by ELISA.Results GV141-hTNFαexpres-sion vectors were constructed successfully which were proved by sequence alignment.Real-Time PCR proved that it contained hTNFαgene in hTNFα/CHO cell line.ELIAS identification results showed that the cell lines can continuously secrete hTNFαwithin a certain cell propaga-tion.Conclusion The hTNFα/CHO cell line can continuously secrete human tumor necrosis factor within a certain cell propagation.

Objective To investigate the influencing factors of in-hospital delay using alteplase for intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods From January 2006 to May 2015,220 consecutive patients with acute ischemic stroke admitted to the Department of Neurology,Tangshan Gongren Hospital Affiliated to North China University of Science and Technology were enrolled retrospectively.They all received alteplase for intravenous thrombolytic therapy.Their mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 16±8.According to door-to-needle time (DNT),they were divided into either a delay group (DNT >60 min;n=151) or a non-delay group (DNT ≤60 min;n=69).The baseline data,laboratory tests,onset-to-door (OTD) time,imaging,and etiology classification of trial of org 10172 in acute stroke treatment (TOAST) of both groups were recorded.Univariate analysis was performed on both groups,and further multivariate logistic analysis was performed.Results (1) The proportion of the past history of transient ischemic attack,blood glucose level on admission,time from onset to hospital in the non-delay group were significantly higher than those of the delay group.There were significant differences between the two groups (43.5%[30/69] vs.3.3%[5/151],7.9±3.0 mmol/L vs.6.9±2.1 mmol/L,95±53 min vs.80±34 min,all P<0.05).There were significant differences in the constituent ratio of TOAST classification between the two groups (P<0.05).There were no significant differences in other baseline data and clinical features between the two groups (all P>0.05).(2) Multivariate Logistic regression analysis showed that the risks of patients with the past history of transient ischemic attack (OR,0.330,95%CI 0.109-0.998,P=0.046),elevated blood glucose levels on admission (OR,0.775,95%CI 0.657-0.914,P=0.005),prolonged onset-to-door time (OR,0.648,95%CI 0.504-0.831,P=0.013),internal carotid artery lesions (OR,0.192,95%CI 0.038-0.960,P=0.044) for occurring in-hospital delay after thrombolysis were low.Systolic pressure on admission(OR,1.275,95%CI 1.091-1.491,P=0.027)and cardioembolism(OR,3.892,95%CI 1.661-9.112,P=0.006) for occurring in-hospital delay after thrombolysisin were high.Conclusion The patients with past history of transient ischemic attack,higher blood glucose,prolonged onset-to-door time,and having internal carotid artery lesions may be cause the attention of family members and doctors,and were less prone to having thrombolytic in-hospital delay,whereas those with higher systolic blood pressure on admission and cardioembolism were prone to having in-hospital delay.

Objective:To develop the method based on deep learning to predict the dose distribution of breast-conserving postoperative intensity-modulated radiotherapy(IMRT) for breast cancer, and to evaluate accuracy of the prediction model.Methods:The data of 110 left-sided breast-conserving postoperative IMRT for breast cancer patients were reviewed, among them, 80 cases were randomly selected for training set, 10 cases for validation set and the remaining 20 cases were used as test set.Firstly, the four-channel characteristics of the patients′ computed tomography(CT) images, regions of interest, distances between voxel and planning target volume(PTV), and corresponding dose distributions were taken as input data.The established U-Net was used for training and obtaining prediction model which was utilized to perform dose prediction on the test set, in order to verify the influence of the features of distance between voxel and PTV in dose prediction, and to compare the dose prediction result with the actual manual planned dose.Results:By incorporating the features of distance between voxel and PTV, the model achieved higher accuracy in predicting the dose distribution.The dose scores and dose volume histogram(DVH) scores of the testing set, consisting of 20 patients, were 2.10±0.18 and 2.28±0.08, respectively, and the predicted dose distribution was closer to the manually planned distribution( t=2.52, 2.40, P<0.05). The deviation between the predicted doses of the PTV and the organ at risk (OAR) and the manually planned doses were within 4%, the average dose to the contralateral breast was increased by 13 cGy, all of them within the clinically acceptable range. Except for the statistically significant differences in D2, D98( Di represents the dose received by i%of the PTV volume), Dmean(mean dose) of PTV 60 and V5( Vi was the volume percentage of OAR receiving i Gy dose.), Dmeanof the ipsilateral lung ( t=3.74, 2.91, 2.99, 3.47, 2.29, P < 0.05), there were no statistically significant differences in other parameters. Conclusions:The deep learning-based method can accurately predict the dose distribution of breast-conserving postoperative IMRT for breast cancer, and it has been proven through experiments that by incorporating the features of distance between voxel and PTV can effectively improve the prediction accuracy, which helps physicists to improve the quality and consistency of treatment planning.

Objective To investigate the involvement of the high mobility group box protein B1 (HMGB1)-Toll-like receptor 2 (TLR2)/TLR4-nuclear factor κB (NF-κB) pathway in the intestinal mucosal injury induced by Cryptosporidium parvum infection, and to examine the effect of oxymatrine (OMT) on C. parvum infection in mice. Methods Forty SPF 4-week-old BALB/c mice were randomly divided into four groups, including the control group, infection group, glycyrrhizin (GA) group and OMT group. Each mouse was orally administered with 1 × 10⁵ C. parvum oocysts one week in the infection, GA and OMT groups following dexamethasone-induced immunosuppression to model C. parvum intestinal infections in mice. Upon successful modeling, mice in the GA group were intraperitoneally injected with GA at a daily dose of 25.9 mL/kg for successive two weeks, and animals in the OMT group were orally administered OMT at a daily dose of 50 mg/kg for successive two weeks, while mice in the control group were given normal food and water. All mice were sacrificed two weeks post-treatment, and proximal jejunal tissues were sampled. The pathological changes of mouse intestinal mucosal specimens were observed using hematoxylin-eosin (HE) staining, and the mouse intestinal villous height, intestinal crypt depth and the ratio of intestinal villous height to intestinal crypt depth were measured. The occludin and zonula occludens protein 1 (ZO1) expression was determined in mouse intestinal epithelial cells using immunohistochemistry, and the relative expression of HMGB1, TLR2, TLR4, myeloid differentiation primary response gene 88 (MyD88) and NF-κB p65 mRNA was quantified in mouse jejunal tissues using quantitative real-time PCR (qPCR) assay. Results HE staining showed that the mouse intestinal villi were obviously atrophic, shortened, and detached, and the submucosal layer of the mouse intestine was edematous in the infection group as compared with the control group, while the mouse intestinal villi tended to be structurally intact and neatly arranged in the GA and OMT groups. There were significant differences among the four groups in terms of the mouse intestinal villous height (F = 6.207, P = 0.000 5), intestinal crypt depth (F = 6.903, P = 0.000 3) and the ratio of intestinal villous height to intestinal crypt depth (F = 37.190, P < 0.000 1). The mouse intestinal villous height was lower in the infection group than in the control group [(321.9 ± 41.1) μm vs. (399.5 ± 30.9) μm; t = 4.178, P < 0.01] and the GA group [(321.9 ± 41.1) μm vs. (383.7 ± 42.7) μm; t = 3.130, P < 0.01], and the mouse intestinal crypt depth was greater in the infection group [(185.0 ± 35.9) μm] than in the control group [(128.4 ± 23.6) μm] (t = 3.877, P < 0.01) and GA group [(143.3 ± 24.7) μm] (t = 2.710, P < 0.05). The mouse intestinal villous height was greater in the OMT group [(375.3 ± 22.9) μm] than in the infection group (t = 3.888, P < 0.01), and there was no significant difference in mouse intestinal villous height between the OMT group and the control group (t = 1.989, P > 0.05). The mouse intestinal crypt depth was significantly lower in the OMT group [(121.5 ± 27.3) μm] than in the infection group (t = 4.133, P < 0.01), and there was no significant difference in mouse intestinal crypt depth between the OMT group and the control group (t = 0.575, P > 0.05). The ratio of the mouse intestinal villous height to intestinal crypt depth was significantly lower in the infection group (1.8 ± 0.2) than in the control group (3.1 ± 0.3) (t = 10.540, P < 0.01) and the GA group (2.7 ± 0.3) (t = 7.370, P < 0.01), and the ratio of the mouse intestinal villous height to intestinal crypt depth was significantly higher in the OMT group (3.1 ± 0.2) than in the infection group (t = 15.020, P < 0.01); however, there was no significant difference in the ratio of the mouse intestinal villous height to intestinal crypt depth between the OMT group and the control group (t = 0.404, P > 0.05). Immunohistochemical staining showed significant differences among the four groups in terms of occludin (F = 28.031, P < 0.000 1) and ZO1 expression (F = 14.122, P < 0.000 1) in mouse intestinal epithelial cells. The proportion of positive occluding expression was significantly lower in mouse intestinal epithelial cells in the infection group than in the control group [(14.3 ± 4.5)% vs. (28.3 ± 0.5)%; t = 3.810, P < 0.01], and the proportions of positive occluding expression were significantly higher in mouse intestinal epithelial cells in the GA group [(30.3 ± 1.3)%] and OMT group [(25.8 ± 1.5)%] than in the infection group (t = 7.620 and 5.391, both P values < 0.01); however, there was no significant differences in the proportion of positive occluding expression in mouse intestinal epithelial cells between the GA or OMT groups and the control group (t = 1.791 and 2.033, both P values > 0.05). The proportion of positive ZO1 expression was significantly lower in mouse intestinal epithelial cells in the infection group than in the control group [(14.4 ± 1.8)% vs. (24.2 ± 2.8)%; t = 4.485, P < 0.01], and the proportions of positive ZO1 expression were significantly higher in mouse intestinal epithelial cells in the GA group [(24.1 ± 2.3)%] (t = 5.159, P < 0.01) and OMT group than in the infection group [(22.5 ± 1.9)%] (t = 4.441, P < 0.05); however, there were no significant differences in the proportion of positive ZO1 expression in mouse intestinal epithelial cells between the GA or OMT groups and the control group (t = 0.037 and 0.742, both P values > 0.05). qPCR assay showed significant differences among the four groups in terms of HMGB1 (F = 21.980, P < 0.000 1), TLR2 (F = 20.630, P < 0.000 1), TLR4 (F = 17.000, P = 0.000 6), MyD88 (F = 8.907, P = 0.000 5) and NF-κB p65 mRNA expression in mouse jejunal tissues (F = 8.889, P = 0.000 7). The relative expression of HMGB1 [(5.97 ± 1.07) vs. (1.05 ± 0.07); t = 6.482, P < 0.05] 、TLR2 [(5.92 ± 1.29) vs. (1.10 ± 0.14); t = 5.272, P < 0.05] 、TLR4 [(5.96 ± 1.50) vs. (1.02 ± 0.03); t = 4.644, P < 0.05] 、MyD88 [(3.00 ± 1.26) vs. (1.02 ± 0.05); t = 2.734, P < 0.05] and NF-κB p65 mRNA [(2.33 ± 0.72) vs. (1.04 ± 0.06); t = 2.665, P < 0.05] was all significantly higher in mouse jejunal tissues in the infection group than in the control group. A significant reduction was detected in the relative expression of HMGB1 (0.63 ± 0.01), TLR2 (0.42 ± 0.10), TLR4 (0.35 ± 0.07), MyD88 (0.70 ± 0.11) and NF-κB p65 mRNA (0.75 ± 0.01) in mouse jejunal tissues in the GA group relative to the control group (t = 8.629, 5.830, 11.500, 4.729 and 6.898, all P values < 0.05), and the relative expression of HMGB1, TLR2, TLR4, MyD88 and NF-κB p65 mRNA significantly reduced in mouse jejunal tissues in the GA group as compared to the infection group (t = 7.052, 6.035, 4.084, 3.165 and 3.274, all P values < 0.05). In addition, the relative expression of HMGB1 (1.14 ± 0.60), TLR2 (1.00 ± 0.24), TLR4 (1.14 ± 0.07), MyD88 (0.96 ± 0.25) and NF-κ B p65 mRNA (1.12 ± 0.17) was significantly lower in mouse jejunal tissues in the OMT group than in the infection group (t = 7.059, 5.320, 3.510, 3.466 and 3.273, all P values < 0.05); however, there were no significant differences between the OMT and control groups in terms of relative expression of HMGB1, TLR2, TLR4, MyD88 or NF-κB p65 mRNA in mouse jejunal tissues (t = 0.239, 0.518, 1.887, 0.427 and 0.641, all P values > 0.05). Conclusions C. parvum infection causes intestinal inflammatory responses and destruction of intestinal mucosal barrier through up-regulating of the HMGB1-TLR2/TLR4-NF-κB pathway. OMT may suppress the intestinal inflammation and repair the intestinal mucosal barrier through inhibiting the activity of the HMGB1-TLR2/TLR4-NF-κB pathway.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.