Vaccination is the most cost-effective means of prevention and control of infectious diseases,and is a prioritized strategy for responding to pandemic diseases.Based on experience related to research and development of vaccines for coronavirus disease 2019(COVID-19),we used literature research and expert consultation methods to screen thirty key technologies in nine sub-fields of vaccine technology,which were ranked according to the importance,urgency,innovation and feasibility so as to show where every key technology stood in relation to others in the pineline.The priorities of development of key technologies for vaccines in response to major emerging infectious diseases were recommended to provide reference for related decision-makers in their effort to rationalize research resources and maximize the benefits.

Objective To analyze the expression levels of the three different subtypes of peroxisome proliferator-activated receptors(PPARs),including PPAR-α,PPAR-β and PPAR-γ,in the ectopic lesion tis-sues of the patients with endometriosis(EMs)in order to provide new methods for this disease diagnosis.Methods The ectopic endometrial tissue samples from 30 patients with EMs treated by laparoscopic surgery in this hospital from April to December 2021 were selected as the experimental group,and the ovarian lesion tissue samples from 30 patients with mature cystic teratoma of the ovary(MCTO)during the same period treated by laparoscopic surgery were selected as the control group.The expression levels of PPAR-α,PPAR-βand PPAR-γ in lesion tissues were detected by using immunohistochemistry,and their expression differences between the experimental group and control group were analyzed.The receiver operating characteristic(ROC)curve was utilized to evaluate the diagnostic value of the ratios of PPAR-α/PPAR-β,PPAR-α/PPAR-γ,and PPAR-β/PPAR-γ for EMs.Results The expression levels of PPAR-α,PPAR-β and PPAR-γ in the lesion tis-sues of the experimental group were significantly higher than those of the control group(P＜0.05).In the pa-tients with EMs,PPAR-α was predominantly expressed(P＜0.05),whereas in the patients with MCTO,PPAR-γ was predominantly expressed(P＜0.05).In the ROC curve of PPAR-α/PPAR-β ratio for diagnosing EMs,when the cutoff value was 1.251,the area under the curve(AUC)was 0.65(95％CI:0.51-0.80),the sensitivity was 90.00％,and the specificity was 50.00％.In the ROC curve of PPAR-α/PPAR-γ ratio for diag-nosing EMs,when the cutoff value was 0.817,AUC was 0.88(95％CI:0.78-0.99),the sensitivity was 96.67％and the specificity was 80.00％.In the curve of the PPAR-β/PPAR-γ ratio for diagnosing EMs,when the cutoff value was 0.755,AUC was 0.91(95％CI:0.82-1.00),the sensitivity was 100.00％,and the speci-ficity was 86.67％.Conclusion The expression of PPAR-α in the ectopic lesion tissues of the patients with EMs is significantly higher than that of PPAR-β and PPAR-γ,while in lesion tissues of the patients with MC-TO,the PPAR-γ expression is predominant.The PPAR-β/PPAR-γ ratio may become a potential biomarker for diagnosing EMs.

Objective:To investigate the clinical efficacy of Yunkang oral liquid combined with dexamethasone and low-molecular-weight heparin in the treatment of recurrent spontaneous abortion (RSA) complicated with pre thrombotic state (PTS), and its effects on thromboelastogram and serum progesterone, β-human chorionic gonadotropin (β- hCG), and helper T cell (Th) 1/Th2 cytokine levels in patients with recurrent spontaneous abortion (RSA).Methods:A prospective selection of 94 RSA patients with PTS admitted to the Baoding Second Central Hospital from January 2015 to December 2020 was conducted. They were randomly divided into two groups using a random number table method, with 47 patients in each group. The control group was treated with dexamethasone combined with low molecular weight heparin, while the observation group was treated with Yunkang oral liquid in addition to the control group. Continuously treat until 12 weeks of pregnancy to evaluate the efficacy of both groups and observe the adverse reactions in both groups. Two sets of thromboelastogram parameters were compared before and after treatment, including clot formation time (K value), clot reaction time (R value), and clot formation rate (α angle), maximum clot strength (MA value), and coagulation comprehensive index (CI), as well as serum progesterone β- hCG, Th1/Th2 cytokine levels. The pregnancy outcomes of the two groups were followed up.Results:The total effective rate of the observation group [95.7%(45/47)] was significantly higher than that of the control group [83.0%(39/47), P<0.05]. After treatment, the K and R values of both groups were significantly prolonged compared to before treatment (all P<0.05), the angle α, MA value, and CI value were significantly reduced compared to those before treatment (all P<0.05); After treatment, the K and R values in the observation group were significantly longer than those in the control group (al P<0.05), The angleα, MA value, and CI value were significantly lower than those of the control group (all P<0.05). After treatment, the levels of β- hCG serum progesterone of the two groups were significantly higher than those before treatment (all P<0.05), and The β-hCG levels of the serum progesterone were all higher than those in the control group (all P<0.05). After treatment, The levels serum Th1 cytokines [interferon-γ (INF- γ), tumor necrosis factor- α (TNF- α)] of both groups were significantly decreased compared to those before treatment (all P<0.05), and the levels of serum Th2 cytokines [interleukin-4, IL-10] were significantly increased compared to those before treatment (all P<0.05); After treatment, the observation group's serum IFN- γ, TNF- α were significantly lower than those of the control group (all P<0.05), and The levels of serum IL-4 and IL-10 were significantly higher than those of the control group all P<0.05). The live birth rate of the observation group was 87.2%(41/47), which was higher than that of the control group [70.2%(33/47)] ( P<0.05). There was no statistically significant difference in the adverse reaction rate between the observation group [6.4%(3/47)] and the control group [4.3%(2/47)] ( P>0.05). Conclusions:The treatment of RSA combined with PTS with Yunkang oral liquid, dexmedroxyprogesterone, and low molecular weight heparin can significantly alleviate blood hypercoagulability, increase reproductive endocrine hormone levels, regulate Th1/Th2 cytokine balance, improve live birth rate and clinical efficacy, and is safe and reliable.

ObjectiveTo observe the effect of ethyl acetate extract of Acanthopanacis Senticosi Radix et Rhizoma seu Caulis on high-fat diet-induced apolipoprotein E gene knockout （ApoE^-/-） mice， and explore its mechanism of treating atherosclerosis by regulating intestinal flora. MethodThirty-two 8-week-old male ApoE^-/- mice were randomly divided into model group， rosuvastatin group （10 mg·kg^-1）， high-， low-dose groups of ethyl acetate extract of Acanthopanacis Senticosi Radix et Rhizoma seu Caulis （75， 25 mg·kg^-1）， with 8 mice in each group. Eight C57BL/6 mice were used as blank group. After 8 weeks of continuous administration， blood was taken to determine the blood lipid level. Enzyme-linked immunosorbent assay （ELISA） was used to detect the contents of related indexes in serum of mice. Hematoxylin-eosin （HE） staining was used to observe the formation of aortic plaque in mice. Cecal contents were collected and 16S rRNA amplicon sequencing was used to detect intestinal flora. ResultCompared with the blank group， the plaque area of the model group was significantly increased with inflammatory infiltration， the contents of triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， inflammatory factors and inducible nitric oxide synthase （iNOS） were increased， while the content of high-density lipoprotein cholesterol （HDL-C） was decreased. Compared with the model group， rosuvastatin group and high- and low-dose groups of ethyl acetate extract of Acanthopanacis Senticosi Radix et Rhizoma seu Caulis could improve the deposition of aortic plaque， reduce the contents of TG， TC， LDL-C， inflammatory factors and iNOS， and increase the content of HDL-C. Compared with the blank group， the relative abundances of Firmicutes and Proteobacteria in the model group increased， while the relative abundance of Bacteroidetes decreased. Alpha and Beta diversity analysis showed that samples of each group could be significantly isolated， and the total number and abundance of intestinal flora species in the model group were low. Compared with the model group， ethyl acetate extract of Acanthopanacis Senticosi Radix et Rhizoma seu Caulis could increase the relative abundance of beneficial bacteria and decrease the relative abundance of pathogenic bacteria. ConclusionEthyl acetate extract of Acanthopanacis Senticosi Radix et Rhizoma seu Caulis was mainly composed of flavonoids， which can treat atherosclerosis by regulating the intestinal flora and improve the pathological changes in the aorta of ApoE^-/- mice induced by high-fat diet. The mechanism may be related to its ability to reduce the level of inflammatory factors， improve antioxidant capacity and repair the disorder of intestinal flora structure.

OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.
Bronchopulmonary Dysplasia/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Respiratory Distress Syndrome, Newborn/epidemiology* ; Retrospective Studies ; Treatment Outcome

Objective:To evaluate component separation technique (CST)for the managetment of abdominal wall defect after resection of abdominal wall tumor.Methods:Clinical data of 12 patients treated by CST form Jan 2016 to Jan 2019 at our two Hospitals were retrospectively analyzed. The abdominal wall defect after tumor radical resection were reconstructed with synthetic mesh.Results:The most common pathological type was dermatofibrosarcoma protuberans (4 cases), followed by desmoid fibroma (2 cases) and abdominal metastasis of colon cancer (2 cases). The maximum diameter of tumor was (5.3±1.5) cm by CT preoperatively.The largest transverse diameter of abdominal wall defect after tumor resection was (9.4±1.4) cm.7 patients were treated with CST. 10 patients used synthetic mesh. Incision-related complications occurred in 3 patients, abdominal hypertension and atelectasis in 1 case and acute myocardial infarction in 1 case. All patients were helped and discharged.One patient died of liver metastasis of colon cancer 17 months after operation, and the other 11 patients had no recurrence of tumor or incisional hernia.Conclusion:Using CST in patients with abdominal wall tumor can effectively close the defect, reconstruct the function of abdominal wall and prevent the occurrence of incisional hernia.

Objective: To explore the effect of high mobility group box-1 protein (HMGB1) on the balance of Th17/Treg in patients with immune thrombocytopenia (ITP). Methods: A total of 30 patients who were first diagnosed as ITP in the Fifth People's Hospital of Datong from July 2017 to April 2018 were selected as the case group, and another 30 healthy volunteers in the corresponding period were taken as the control group. The proportion of Th17 and Treg cells was detected by using flow cytometry, and the concentration of HMGB1, interleukin (IL)-17 and transforming growth factor β (TGF-β) in plasma was tested by using enzyme-linked immunosorbent assay (ELISA). Isolated peripheral blood mononuclear cells (PBMC) were cultured in vitro. After the treatment with recombinant human HMGB1 (rhHMGB1), real-time polymerase chain reaction (RT-PCR) was applied to detect the mRNA expression changes in Treg cell transcription factor intracellular forkhead helix transcription factor 3 (Foxp3) and Th17 cell transcription factor retinoid related orphan receptor γt (RORγt). The differences of indicators in Treg cell transcription factor peripheral blood between the case group and the control group were compared, and the balance correlation between HMGB1 and Th17/Treg was analyzed. Results: Compared with the healthy control group, the proportion of Th17 cells and the expression level of HMGB1 and IL-17 in peripheral blood of ITP patients were increased (all P < 0.01), while the proportion of Treg cells and the level of TGF-β were decreased (all P < 0.01). The proportion of Th17 cells and the expression level of IL-17 and HMGB1 in peripheral blood of ITP patients were positively correlated with the concentration of HMGB1 (all P < 0.01); the proportion of Treg cells and the level of TGF-β were negatively correlated with the expression level of HMGB1 (all P < 0.01). In vitro experiments, the expression of intracellular RORγt mRNA was increased compared with the negative control group (1.50±0.24 vs. 0.93±0.22, t = 9.612, P < 0.01), and the expression of Foxp3 mRNA was decreased compared with the negative control group after the stimulation of PBMC by rhHMGB1 (0.72±0.19 vs. 1.08±0.18, t = 7.387, P < 0.01). Conclusion The high level of HMGB1 in the peripheral blood of ITP patients induces Th17/Treg imbalance and aggravates inflammatory reactions, which may be an important cause of ITP.

Objective Gastrointestinal fistula is a serious complication after operation. It is reported that the over-the-scope-clip(OTSC) can close intestinal full-thickness wall and treat gastrointestinal fistula effectively. This study was to investigate the efficacy of OTSC in the treatment of gastrointestinal fistula.Methods We analyzed the clinical data of 28 postoperative patients with gastrointestinal fistula who underwent endoscopic closure using OTSC in Endoscopy Center of Research Institute of General Surgery in our hospital from October 2014 to October 2017, and recorded the course of disease, the site of gastrointestinal fistula, the diameter of fistula and the efficacy of OTSC. Patients with successful closure were followed up for half a year after hospital discharge to observe the recurrence of fistula.Results Endoscopic closure with OTSC was successful in all the 28 patients without complications like bleeding and falling off. In the sinus tract or digestive tract radiography at 1-2 weeks after OTSC closure, 23 patients were successful in endoscopic closure(82.14%). In the six months′ follow-up of 23 patients with successful treatment, 4 patients were lost to follow-up and 19 patients were successful without recurrence of fistula.Conclusion The endoscopic closure of gastrointestinal fistula using OTSC is safe and effective, avoiding reoperation and reducing trauma.

Objective To discuss the effect of whole course comprehensive nursing intervention on postoperative pain of patients with joint replacement.Methods 116 cases who had joint replacement were randomly divided into the control group (n =57) and the intervention group (n =59).Both groups received conventional nursing before and after surgeries,and the intervention group received whole course comprehensive nursing intervention in addition,which included preoperative nursing intervention according to patient' s social background,standard of culture and psychological quality,whole course accompany during surgery,postoperative pain nursing intervention and follow-up after discharge.Intervention effect was compared between two groups.Results Pain degree was lower in the intervention group than in the control group.Pain score 8 hours after operation was (6.54 ± 1.65) in the intervention group and (9.63 ± 1.73) in the control group,and the difference was statistically significant (t =9.84,P ＜ 0.01).The first leaving bed time was (13.62 ± 4.28) h in the intervention group and (19.83 ±5.27) in the control group,hospitalization time was (14.17 ±2.43) d in the intervention group and (17.67 ± 3.51)d in the control group,treatment cost was (17.67 ± 3.51) yuan in the intervention group and (7 581.38 ± 55.24) yuan in the control group,and the differences were statistically significant (t =6.95,6.22,183.64,respectively ; P ＜ 0.01).Score of life quality was (5.92 ± 0.33) in the intervention group and (3.78 ± 0.25) in the control group,and the difference was statistically significant (t =39.45,P ＜ 0.01).Conclusions The implementation of whole course comprehensive nursing intervention for joint replacement patients can effectively relieve their postoperative pain,enhanced their pain tolerance,improve their comfort,quality of life and sleep quality,reduce postoperative complications,shorten average hospital stay,and raise their satisfaction and treatment effect,thereby improving the quality of holistic nursing care.

Objective To study the role of inositol requiring enzyme 1 (IRE1)-mediated endoplasmic reticulum stress on hepatocyte apoptosis of experimental fulminant hepatic failure (FHF).Methods Thirty male depuratory Wistar rats were manufactured to be FHF model by peritoneal injection of D-galactosamine (D-GalN) and lipopolysaccharide (LPS),and 30 rats were injected peritoneally with 0.9％ sodium chloride solution as controls.The apoptosis of liver cells was detected by flow cytometry.The protein and mRNA expressions of Caspase-12 and IRE1 in liver tissues were detected by immunohistochemistry and reverse transcriptation-polymerase chain reaction (RT-PCR).The independent samples were compared by Kruskal-Wallis H test.The comparison between two groups at the same time point was done by Mann-Whitney U test.The correlation analysis was done by rank correlation.Results The apoptotic rates of liver cells at 2,4,8 and 12 hours were increased over time in model group (x2 =25.475,P=0.01),which were higher than control group (U=0,P＜0.01).The expressions of Caspase-12 and IRE1 proteins in liver tissues were upregulated in model group,while the expressions were not detected in control group.The expressions of Caspase-12 and IRE1 mRNA in model group were also increased over time and peaked at 8 h,then gradually decreased; the differences among different time points were statistically significant (x2 =23.983,x2 =24.820; both P＜0.01),and all higher than control group (U=0,P＜0.01).IRE1 was positively correlated with both Caspase-12 and hepatocellular apoptotic rate (r=0.733 and 0.715,respectively;both P＜0.01).Caspase-12 was positively correlated with hepatocellular apoptotic rate (r=0.586,P＜0.01).Conclusions IRE1 mediated endoplasmic reticulum stress on hepatocyte apoptosis is closely related to the development of FHF.The earlier intervention on endoplasmic reticulum stress pathway,the more protective effect in liver failure.