Objective To produce human papillomavirus type 6(HPV-6)virus-like particles with Escherichia coli expression system and study its immunogenicity.Methods HPV-6 L1 gene was inserted into pmkaryotic expression vector pTO-T7 and then expressed in Escherichia coli ER2566.The HPV-6 L1 protein was purified by ammonium sulfate precipitation,ion-exchange chromatography,and hydrophobic interaction chromatography.Then the purified HPV-6 L1 self-assembled into virus-like particle after removing 1,4dithiothreitol(DTr).The morphology of the virus-like particles was investigated with dynamic light scatter and transmission electron microscopy,and the immunogenicity was determined with in vitro pseudownons neutralization as8ay.Results HPV-6 L1 was expressed in soluble form in Escherichia coli.Following the removal of DTT,purified HPV-6 L1 protein could assemble into virus-like particles as 25 am in the radius.And the animal immunization test showed HPV-6 virus-like particles can elite hish titer neutralizing antibodies.Conclusion The bacterially expressed HPV-6 L1 VLP is highly immunogenieity and easy to produce.And it can be good candidate of HPV-6 vaccine.

Stroke is a cerebrovascular disease that damages brain tissue due to blockage or rupture of blood vessels, and is one of the leading causes of death and disability worldwide. Diagnosing, monitoring stroke and the treatment effects all rely on neuroimaging that detects changes in the brain. Near-infrared spectroscopy (NIRS) is a novel neuroimaging technique which is based on the non-invasively measuring of concentration changes of oxyhemoglobin and reduced hemoglobin. This review summarizes the underlying mechanisms of NIRS and its current clinical application in stroke, as well as the limitations of NIRS in broader clinical applications.

Objective To evaluate percutaneous AngioJet thrombectomy in the treatment of iliofemoral deep venous thrombosis (DVT).Methods A total of 36 patients with 38 legs of lower extremity DVT treated by AngioJet mechanical thrombectomy from Feb 2016 to Dec 2016 were analyzed retrospectively.The effect of lower limb venous recanalization was evaluated by observing the intraoperativeangiography and the results of postoperative follow-up including complaints,signs,and lower extremity venous ultrasound or CT and Villalta scores.Results Thrombosis was completely dissolved by AngioJet thrombectomy device in 32 out of 38 legs (84.2％) at first stage.Slight bleeding occurred in 4 cases,1 patient could not tolerate the operation.23 patients were followed-up for 6 months,venous patency was present in 21 of 23 patients (91.3％).11 patients complete the one-year follow-up,9 patients (81.8％) were in the 0-4 Villalta group.Conclusions AngioJet can effectively and safely remove thrombus in the lower extremity deep venous system.It is especially advantageous for patients who have contraindications for thrombolysis with a satisfactory short term venous patency.

Objective To analyze the viability of extended distal pancreatectomy and the associated prognostic factors.Methods The data of 57 patients with pancreatic adenocarcinoma who underwent standard distal pancreatectomy (DP) or extended distal pancreatectomy (EDP) from January 2011 to December 2014 were reviewed retrospectively.Thirty-five patients were performed with DP and 22 with EDP.Operation safety and survival benefit between DP and EDP were compared by t-test or x2 test.Cox regression analysis was used to explore the prognostic indicators.Results Compared to DP group,operation time((255 ±91)min vs.(208 ±80)min)(t =2.066,P =0.044) and ratio of blood transfusion (50.0％ vs.17.1％) (x2 =12.836,P =0.008) were greater in EDP group,respectively.There were no significant differences in amount of intraoperative blood loss and postoperative duration of hospitalization.Delayed gastric emptying was greater in EDP(22.7％ vs.2.9％) (Z =-2.251,P =0.027),while other complications had no differences.Mortality and ratio of relaparotomy also showed no differences.Median survival following DP was 13.1 months compared to 8.2 months following EDP.There was no difference in survival between DP and EDP.According to the results of multivariate analysis,tumor size (RR =1.275,P =0.03) and perioperative blood transfusions(RR =2.673,P =0.04) were independent prognostic factors.Conclusions Though patients with pancreatic adenocarcinoma who undergo EDP have a worse pathologic staging,they will gain a comparable long-term survival to the patients undergo DP.Tumor size and perioperative blood transfusions are independent prognostic factors.

Objective To analyze the viability of extended distal pancreatectomy and the associated prognostic factors.Methods The data of 57 patients with pancreatic adenocarcinoma who underwent standard distal pancreatectomy (DP) or extended distal pancreatectomy (EDP) from January 2011 to December 2014 were reviewed retrospectively.Thirty-five patients were performed with DP and 22 with EDP.Operation safety and survival benefit between DP and EDP were compared by t-test or x2 test.Cox regression analysis was used to explore the prognostic indicators.Results Compared to DP group,operation time((255 ±91)min vs.(208 ±80)min)(t =2.066,P =0.044) and ratio of blood transfusion (50.0％ vs.17.1％) (x2 =12.836,P =0.008) were greater in EDP group,respectively.There were no significant differences in amount of intraoperative blood loss and postoperative duration of hospitalization.Delayed gastric emptying was greater in EDP(22.7％ vs.2.9％) (Z =-2.251,P =0.027),while other complications had no differences.Mortality and ratio of relaparotomy also showed no differences.Median survival following DP was 13.1 months compared to 8.2 months following EDP.There was no difference in survival between DP and EDP.According to the results of multivariate analysis,tumor size (RR =1.275,P =0.03) and perioperative blood transfusions(RR =2.673,P =0.04) were independent prognostic factors.Conclusions Though patients with pancreatic adenocarcinoma who undergo EDP have a worse pathologic staging,they will gain a comparable long-term survival to the patients undergo DP.Tumor size and perioperative blood transfusions are independent prognostic factors.

Crohn’s disease is a chronic intestinal inflammatory disorder of unknown etiology. Although the pharmacotherapies for Crohn’s disease are constantly updating, nutritional support and adjuvant therapies have recently gained more attention. Due to advancements in clinical nutrition, various clinical nutritional therapies are used to treat Crohn’s disease. Doctors treating inflammatory bowel disease can now offer several diets with more flexibility than ever. The Crohn’s disease exclusion diet is a widely used diet for patients with active Crohn’s disease. The Crohn’s disease exclusion diet requires both exclusion and inclusion. Periodic exclusion of harmful foods and inclusion of wholesome foods gradually improves a patient’s nutritional status. This article reviews the Crohn’s disease exclusion diet, including its structure, mechanisms, research findings, and clinical applications.

Objective:To evaluate the characteristics of vaginal flora between normal and abnormal pregnant women throughout pregnancy.Methods:Vaginal swab specimens were collected from pregnant women in the first (<14 gestation weeks, GW), second (14~28 GW) and third trimester (>28 GW) in Anqing, Anhui Province from February 2018 to February 2020. Pregnant women were divided into normal and abnormal groups according to all clinical diagnosis. The sequences of 16S rRNA gene (V3-V4) from vaginal swabs were analyzed using QIIME2 platform. The differences in the dominance of Lactobacillus, community state type (CST) transition, Alpha diversity and Beta diversity were analyzed. Diversity data after log transition were used in the analysis of linear mixed model. Results:A total of 34 pregnant women (10 normal and 24 abnormal) with 102 samples were included for analysis. The composition of vaginal flora between two groups: the relative abundance of Lactobacillus was the highest at the genus level and Lactobacillus crispatus and Lactobacillus iners was the top two species with high relative abundance. The dominance of Lactobacillus, Alpha diversity and transition of CST were also similar. Both groups had a gradually decreased trend of Alpha diversity with GW, and the Chao1, Observed species and Faith′s PD indexes′ were different in different GW ( P<0.05). All Beta diversity metrics in normal group had descending trend, with lower value of the index of first distance which implied a higher microbiota stability, while Bray-Curtis, Weighted UniFrac distance had ascending trend in abnormal group, indicating lower stability. Jaccard distance′s first distance was statistically differed among GW and Unweighted UniFrac distance′s differed between normal and abnormal groups. Conclusions:The first distance of Unweighte UniFrac distance in abnormal pregnant women is higher than that of normal pregnant women and the vaginal flora in abnormal group has lower stability.

Objective Using network pharmacology to explore the mechanism of action of tripterygium wilfordii-white peony in the treatment of rheumatoid arthritis(RA)and validating it using an adjuvant arthritis rat model.Methods Obtain the effective ingredients of tripterygium wilfordii and white peony through TCMSP database and predict the action targets;Obtain the disease targets of RA using DisGeNET and GeneCards online database;Draw the network of"tripterygium wilfordii-white peony-active ingredient-RA"and screen the core effective components using the software Cytoscape 3.9.1;Construct the protein-protein interaction(PPI)network using String database and screen the core targets using the CytoNCA plug-in,using the Metascape database for gene enrichment analysis of common targets,and using Auto Dock Tools and Pymol software for molecular docking of core active ingredients and targets.Enzyme linked immunosorbent assay(ELISA)detection of serum tumor necrosis factor-α(TNF-α),interleukin(IL)-4,IL-6,and IL-17 levels in adjuvant arthritis rats,Western blot was used to detect the expression of phosphorylated phosphatidylinositol 3-hydroxy kinase(p-PI3K)and phosphorylated AKT protein(p-AKT),validate the results of network pharmacology analysis.Results There were a total of 61 effective ingredients in the treatment of RA with tripterygium wilfordii-white peony,with 116 targets and 191 signaling pathways involved.Animal experiments have shown that compared with the model group rats,the serum cytokine TNF-α,IL-6 and IL-17 of rats in tripterygium wilfordii-white peony group and tripterygium wilfordii extract group were significantly decreased(P<0.05),IL-4 significantly increased(P<0.05);The expression of p-PI3K and p-AKT in synovial tissue was significantly reduced(P<0.05);Compared with rats in tripterygium wilfordii extract group,the TNF-α,IL-6,IL-17,p-PI3K and p-AKT of rats in tripterygium wilfordii-white peony group were significantly reduced(P<0.05),while IL-4 was significantly increased(P<0.05).Conclusion Tripterygium wilfordii-white peony can inhibit the overexpression of phosphatidylinositol 3-hydroxy kinase(PI3K)/protein kinase B(AKT)signaling pathway,regulate cytokine release,exert anti-inflammatory effects,and ultimately treat RA through multiple active ingredients and targets.

OBJECTIVE To explore the correlation between drug consumption index and diagnosis related groups （DRG） overspending cases， and provide a basis for hospitals to optimize the cost structure and strengthen the refined management. METHODS Based on the data of DRG patients enrolled in a third-grade class A hospital from September to November 2023， the multivariate Logistic regression model and restricted cubic spline （RCS） model were used to analyze the correlation of drug consumption index with DRG overspending cases and its threshold effect， respectively. At the same time， rational drug use evaluation was conducted based on the drug consumption index， precise cost control and management were carried out， and the changes in the main pharmaceutical indicators of the whole hospital were analyzed before control （January-June 2023） and after control （January-June 2024）. RESULTS The results of multivariate Logistic regression analysis showed that long hospitalization days， high drug consumption index， transfer to other departments and combined diabetes mellitus were the risk factors for DRG overspending （P＜0.05）. The results of the RCS model showed that the drug consumption index had a non-linear relationship with DRG overspending. When the drug consumption index was ≥0.64， the drug consumption index was positively correlated with the risk of DRG overspending（P＜0.05）. Compared with the same period before the control， medical cost per time， drug cost per time and drug consumption index decreased significantly after the control （P＜0.01）. CONCLUSIONS The drug consumption index is a risk factor for DRG overruns， there is a non-linear relationship and threshold effect between it and DRG overruns. Each hospital can set a reasonable threshold and implement dynamic monitoring and intervention by comprehensively considering the actual drug usage， disease spectrum characteristics， and cost control targets， as well as factors such as medical quality， patient needs， and the payment capacity of medical insurance， which can effectively achieve precise control over drug usage.

Objective:To investigate the clinical advantages of absorbable barbed wires in laparoscopy combined with choledochoscopy treatment of gallbladder polyps.Methods:The clinical data of 103 patients with gallbladder polyps who received laparoscopy combined with choledochoscopy treatment in The First People's Hospital of Lianyungang from February 2016 to March 2018 were retrospectively analyzed. Sixty-five patients in the observation group underwent gallbladder wall sutures with absorbable barbed wires, and thirty-eight patients in the control group underwent gallbladder wall sutures with common absorbable wires. The operative time, gallbladder wall suture time, intraoperative blood loss, average hospitalization time, and postoperative bile leakage were compared between the two groups.Results:There were no significant differences in intraoperative blood loss and average hospitalization time between the two groups ( P = 0.312, P = 0.114). In the observation group, gallbladder wall suture time and operative time were (5.58 ± 1.14) minutes and (60.71 ± 11.03) minutes, respectively, which were shorter than (6.32 ± 1.04) minutes and (68.24 ± 9.61) minutes in the control group ( t = 3.23, 3.50, P = 0.002, 0.001). No bile leakage occurred in the observation group and bile leakage occurred in four (10.5%) patients in the control group. There was a significant difference in bile leakage between the observation and control groups ( χ2 = 4.57, P = 0.032). Conclusion:Absorbable barbed wires for gallbladder wall sutures during operation in laparoscopy combined with choledochoscopy treatment of gallbladder polyps is safe and feasible. It can markedly shorten gallbladder wall suture time and operative time, decrease the incidence of bile leakage, and has a clinical advantage over common absorbable wires.