Objective This study was to evaluate breast fiberoptic ductoscopy (FDS) in the diagnosis and treatment of abnormal niple discharge(AND). [WT5”HZ]Methods [WT5”BZ] FVS 3500 superfine fiberscopy system was used to treat and diagnose 200 cases with AND. [WT5”HZ]Results [WT5”BZ] 210 orifices of nipple discharge were found in this group. FDS was successfully inserted into 204 orifices(97 0%).Early breast cancer was found in 9 cases(4 5%), papilloma and papillomatosis in 66 cases(33 0%),ductal ectasia and/or chronic inflammation in 96 cases(48 0%); “normal duct” in 29 cases(14 5%). Duct endoscopic biopsy was carried out in 10 cases. Chronic inflammation was cured by perfusion in 25 cases. 67 cases underwent surgery, diagnosis was confirmed by pathology in 95 0% with a positive rate 3 times as high as that of smear cytology.Conclusions FDS enables the evaluation on 4th ductal lumen and detection of early breast cancer. Interventional treatment was successful in some intraductal papilloma and chronic inflammatory disease.

Objective To discuss the levels of evidence provided by different study designs.Methods Websites of N Engl J Med, JAMA, Lancet, and BMJ were accessed to identify research articles (systematic review and meta-analysis included) published in 2009. A standardized data collection form was established using Epidata 3. 1 software to extract the "title", "country of lead author", "clinical problem" (such as treatment, diagnosis, etc. ) and "study design" of eligible studies. Descriptive statistics was conducted with SPSS 13.0. Results Over all, 844 studies were included, among which 35.7% were RCT,9. 4% systematic review and Meta-analysis, and 54. 9% other types of studies. Regarding clinical problems,34. 2%, 19. 7%, 13.7%, 6. 0% and 5. 1% of the included researches addressed the issues of treatment,etiology/risk factors, prevention, disease frequency and prognosis, respectively. The study designs that were most frequently adopted to explore these problems were RCT (70.6%), cohort study (44. 6% ), RCT (68. 1% ), cross-sectional study ( 56. 9% ), and cohort study ( 93.0% ), respectively. Conclusions High-level evidence does not come exclusively from RCT and systematic review, as each type of study may have its unique value in health related research. The clinical problem of interest, the previous work that has been done to approach the same issue, as well as other factors should be taken into account when deciding whether the selected study design is appropriate.

AIM　To determine whether O-β -D-fructofuranosyl-〔(2→1 )-O-β-D-fructofuransyl〕4α-D-glucopyranoside (inulin-type hexasaccharide, IHS), a monomer extracted from the roots of Morinda of ficinalis How, has antidepressant action. METHODS Fo rced swimming tests in mice and rats and differential-reinforcement-of-low-r ate 72 second schedule (DRL 72 s) in rats were used. RESULTS In the forced swimming test in mice, IHS (80 mg*kg-1, po), like the effe ct of clinically effective antidepressant desipramine (10 mg*kg-1, ip)， produced significant decrease in immobility time. IHS (20 mg*kg-1，po ) also elicited significant decrease in immobility time in forced swimming test in rats, which was comparable to the effect of desipramine (40 mg*kg-1, po). Moreover, in the DRL 72 s in rats, IHS (5～10 mg*kg-1, ip), s imilar to desipramine (5 mg*kg-1, ip), elicited significant increase in reinforcers. CONCLUSION These findings demonstrate that IHS has antidepressant action and is an effective component extracted from the root s of Morinda officinalis How.

Objective To investigate the effect of triptolide (TP) on the expression of hypoxia inducible factor 1 alpha (HIF1α) and vascular endothelial growth factor (VEGF) in the human umbilical vein endothelial cells (HUVECs) under hypoxia. Methods (1) HUVECs were treated with 0, 40, 80, 160 and 320 nmol/L TP (named with hypoxia group, TP40 group, TP80 group, TP160 group and TP320 group, respectively) under the hypoxic condition (37℃, 5%CO2, 1%O2, 94%N2) for culturing 12 hours. Meanwhile, cells cultured under normoxia condition (without TP added) were set as the normoxia group. Western blot assay was used to detect the expression of HIF1αin each group. (2) The cells were divided into normal control group, hypoxia group and TP80 group. The immunofluorescence method was performed to detect the localization of HIF1α in cells. (3) Expressions of VEGF were detected by Western blot assay in TP80 group and hypoxia group. (4) The cells were divided into hypoxia group, TP80 group, TP80+KF20 group (80 nmol/L TP and 20μmol/L KC7F2), and TP80+KF30 group (80 nmol/L TP and 30 μmol/L KC7F2). After 12-hour culturing, Western blot assay was used to detect the expressions of HIF1α and VEGF in each group. Results (1) Under the normoxia condition, no HIF1α was detected in HUVECs. The expression level of HIF1αwas significantly increased in TP80 group than that in hypoxia group (P<0.05), while there was no significant change in expression of hypoxia HIF1αin TP160 group and TP320 group compared with that of hypoxic group. (2) The immunofluorescence result showed that HIF1α was mainly expressed in the nucleus. (3) The expression of VEGF was significantly increased in TP80 group than that in hypoxia group (P < 0.05). (4) After the intervention of KC7F2, HIF1αand VEGF expression levels were significantly decreased in the TP80+KF20 group and the TP80+KF30 group than those in the TP80 group (P<0.05). Conclusion TP can improve the expression of HIF1αand VEGF to accelerate the proliferation of endothelial cells under hypoxia condition.

Objective:To explore the clinical effects of hair transplantation combined with SVF GEL assisted fat transplantation in treating cicatricial alopecia.Methods:Eleven patients (5 males and 6 females, ranging from 22 to 41 years old) with cicatricial alopecia caused by burn or tumor excision in Shanghai Mylike Cosmetic Hospital from October 2017 to August 2019. All patients were treated with hair transplantation combined with SVF GEL assisted fat transplantation according to their scar areas.Results:Patients were followed up for 11 months on average, their hair grew well, with significantly improved appearances and no obvious complications. Hair follicle detection system was used to analyze the hair density after transplantation. The average survival rate reached 90.26% in accompany with desirable patients＇ satisfactory rates.Conclusions:Excellent results can be achieved by conducting hair transplantation combined with SVF GEL assisted fat transplantation in treating cicatricial alopecia, which is worth clinical application.

Objective To compare the diagnostic index which used to evaluate the balance of covariates between groups in real world study(RWS).Methods Simulate RWS simulation data scenarios such as different inter group equilibrium degree,different covariate and exposure,outcome relationship,etc.by constructing the correlation model between each diagnostic index and estimation deviation,evaluate the accuracy and robustness of different single covariate and global covariate diagnostic indexes.Results In addition to L1 measure,standardized difference,overlap coefficient,K-S distance,Lévy distance,Mahalanobis distance and general weighted difference can distinguish different degrees of inter group covariate equilibrium.The R2 of the correlation models estimated by the C-statistic based on propensity score and the general weighted difference diagnostic index is greater than 0.8,and the intercept value approaches the origin,which is the most accurate and stable for the diagnosis of inter group equilibrium.Conclusion The single covariate diagnosis index can evaluate the balance of covariates between groups of RWS data,but the accuracy,sensitivity and robustness of the global diagnosis index are better.Among them,the diagnosis effect of L1 measure is poor,while of the C-statistic based on propensity score is the best.

Objective:To analyze the performance characteristics of the energy output of defibrillation device at different lifecycle stages of the equipment,and to improve the level of management,so as to ensure the safety and effectiveness of using the device.Methods:A total of 90 defibrillation devices of using 10 types included 861290 and CardioServ(included scrapped devices)during the period of 2015-2022 were retrospectively analyzed.The detected data of energy output of defibrillation device were analyzed as statistical method,and the error of releasing energy was calculated.A total of 36 defibrillation devices that were in the early stages of use(at the first three years of device use)were divided into the first year,the second year and the third year,and the data of energy outputs of devices among three years were compared.The data of the type A and type B defibrillation devices,which were the largest number of devices in the normal stage of use(the middle stage of use),were calibrated according to the energy release in the three years between 2018 and 2000.The difference of releasing energy at the preseted value of 100J between the two types of devices was analyzed.Finally,the errors of energy releases of 8 devices,which energy outputs exceeded the deadline,in the scrap period between 2015 and 2022 were summarized.Results:In the data of three groups of devices in the early stages of use,the differences at the first and second year of device use among 100J,150J and 200J of the energy releases of the preseted values were significant(t=-0.17,-0.17,-0.58,P>0.05).The difference of the measured values between the first and third years of device use was not significant(Z=-0.70,-0.38,-0.86,P>0.05).The results of variance analysis of repeated measurement of the energy releases of the devices in normal stage indicated that the difference of the energy release at 100J preseted point among different types of 41 devices was significant(F=4.40,P<0.05).The energy release of type X defibrillator appeared constantly high,and the relative error increased with the increasing of preseted values.The repeatability of the device was better,and the relationship between preseted energy(x)and release energy(y)conformed to linear relationship(R2=0.9985).In these defibrillation devices that were using,the qualified rate of energy output of>100J preseted point was 97.68%.Conclusion:There is slight difference in the mean value of energy release between different type of defibrillation devices within the qualified range,and the energy release still is a performance indicator that should be highly focused for defibrillation devices.We should combine with the maintenance and repair data of device to conduct in-depth analysis,so as to grasp the operating status of the device,and optimize the strategy of quality control,and ensure the safety of defibrillator in clinical use.

Objective: To understand the prevalence of school bullying and the comorbidity of anxiety and depressive symptoms among middle school students and their association, so as to provide a basis for developing related intervention strategies. Methods: From September to December 2023, a multistage random cluster sampling was employed to select 107 851 middle school students across 104 counties in Anhui Province. The Center for Epidemiological Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7) Scale were used to assess depressive and anxiety symptoms. Logistic regression analysis was utilized to examine the correlations between experiences of school bullying and the comorbidity of anxiety and depressive symptoms. Results: The findings revealed that 2.80% of middle school students had experienced school bullying in the past 30 days. Additionally, 27.03% exhibited potential symptoms of depression, 8.94% showed signs of anxiety symptom, and the comorbidity rate of anxiety and depressive symptoms was 8.04%. Logistic regression analysis showed that statistically significant correlations were identified between experiences of school bullying and increased risks of depressive symptoms (OR=6.42, 95%CI=5.93-6.94, P<0.01), anxiety symptoms (OR=5.94, 95%CI=5.47-6.44, P<0.01), and their comorbidity (OR=6.38, 95%CI=5.88-6.93, P<0.01). Compared with those who did not suffer from school bullying, junior high school students, ordinary senior high school students, vocational senior high school students, boys and girls who suffered from school bullying all had increased risks of comorbidity of anxiety and depressive symptoms (OR=7.25, 5.55, 4.80, 6.42, 6.27, P＜0.01). Conclusions The study underscores the significant impact of school bullying on increasing the risk of comorbidity of anxiety and depressive symptoms among middle school students. It is important to pay attention to the psychological health of bullied students and implement timely psychological intervention measures.

The widespread availability real-world study (RWS) offers valuable insights into disease treatment, disease management, and socio-economic status in routine practice, as well as cautionary tales and methodological challenges such as the discovery of sample heterogeneity and bias of data and its correction. This paper summarizes the common bias and its control in the process of design, implementation and analysis for RWS in order to promote the standardization and rationality of the implementation of RWS.

OBJECTIVE：To investigate the effects of Buyang huanwu decoction on lipid metabolism and hepatic tissue in hyperlipemia model rats. METHODS ：Male SD rats were randomly divided into blank control group ，model group ，positive control group （simvastatin 0.004 g/kg），Buyang huanwu decoction low-dose and high-dose groups （3.5，14.0 g/kg，by crude drugs），with 10 rats in each group. Except that blank control group was given water intragastrically ，hyperlipidemia mode of other groups was established by intragastric administration of fat emulsion according to the body weight. From the 21st day after modeling，the rats in each group were given water or fat emulsion in the morning and water or corresponding drugs in the afternoon for consecutive 20 days. After last medication ，the contents of TG ，TC，LDL-C，ALT，AST，LCAT，PLTP and HL in plasma were determined in each group ；the contents of LPL ，MTP and HMG-CoA redutase in liver tissue were also determined. The pathological changes of liver tissue were observed in each group. RESULTS ：Compared with blank control group ，the contents of TG ，TC，LDL-C，ALT and HMG-CoA reductase were increased significantly in model group （P＜0.05 or P＜0.01），while the contents of HL ，LPL and MTP were decreased significantly （P＜0.01）. Compared with model group ，the contents of TG ，TC， LDL-C and HMG-CoA reductase in administration groups as well as the contents of ALT ，AST in Buyang huanwu decoction low-dose and high-dose groups were decreased significantly （P＜0.05 or P＜0.01）；the contents of HL and MTP in administration groups as well as the content of LPL in positive control group were increased significantly （P＜0.05 or P＜0.01）. Pathological sections showed that the hepatocytes of model group were arranged irregularly ，and there was obvious cell steatosis. The hepatocytes in positive control group and Buyang Huanwu decoction high-dose group had almost no abnormal change compared with blank control gr oup，and there was a small amount of slight cell steatosis in Buyang Huanwu decoction low-dose group. CONCLUSIONS ： Buyang huanwu decoction has a 础。E-mail：zhang520-888@163.com significant lipid-lowering effect on hyperlipemia model rats ，which may be related to the regulation of lipid absorptiontransport and metabolism by regulating the expression of lipid 126.com metabolism related enzymes and transporter.