Objective:To explore a better measurement mode of shear wave elastography (SWE) in the skin of lymphedema limbs, and to test its diagnostic efficacy in lymphedema.Methods:Between 1st and 10th August, 2023, 22 healthy volunteers were recruited in the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ulrasound, the First Afiliaed Hospital of Sun Yat-Sen University to measure the Young's modulus (E-value) of limb skin by SWE using a gel pad (GP group) and the thick-layer coupling gel (CG group) respectively. Then between 15th August and 28th September, 2023, 11 patients with 13 lower limb lymphedema, who were treated in the Department of Microsurgery, Orhopaedic Trauma and Hand Surgery, the First Affiliaed Hospital of Sun Yat-Sen University, were consecutively enrolled to find out the E-value of skin in oedematous limbs. The receiver operating characteristic curve (ROC) was constructed and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated to evaluate the diagnostic efficiency. SPSS 26.0, R studio and GraphPad Prism 8 software were used for statistical analysis. Paired sample non-parametric test (Wilcoxon signed rank test) was used to compare the difference in E-value between the 2 groups. P<0.01 was considered statistically significant. Spearman correlation test was used to analyse the correlation of E-value values between the GP group and CG group. Results:Overall, it was found from the healthy volunteers that E-value of skin in distal limbs were higher than that in proximal limbs, especially in lower extremities. E-value of all scanned location in GP group were found higher than those of CG group with statistically significant difference ( P<0.01), and the values of interclass correlation coefficient (ICC) showed a good repeatability. The 11 patients with lymphedema in 13 lower extremities were examined with the thick-layer coupling gel. The skin E-value in calf of patients with lymphedema were significantly higher than that of the healthy volunteers ( P<0.01), except the skin of thighs ( P>0.01). A lymphedema was diagnosed while either a skin E-value was 27.6 kPa calculated by Youden index or with the thickness of skin was 2.3 mm. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of a lymphedema were found at 92.3%, 100%, 100%, 95.7% and 97.1%, respectively. The area under curve (AUC) of ROC was 0.962. The correlation coefficients (R) of E-value in arm, forearm, thigh and lower leg in the GP group and CP group were 0.665, 0.882, 0.850 and 0.815, respectively, which were all significantly correlated. Conclusion:Application of thick layer coupler in ultrasound skin SWE is highly feasible, and the combination of ultrasound skin SWE and skin thickness has higher diagnostic efficiency in the diagnosis of lower extremities lymphedema. It allows more accurate ultrasonic image technical support for early monitoring and diagnosis of lymphedema, microsurgical treatment and a quantitatively perioperative evaluation.

Objective:To assess the feasibility of shear wave elastography (SWE) in differentiating inflammatory and fibrotic strictures in Crohn's disease (CD) .Methods:A cross-sectional survey study was conducted. The patients with stricture-type CD who underwent SWE examination at the First Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2023 were continuously collected. The general data, laboratory examination indicators, and ultrasound examination indicators were collected. Laboratory examination indicators included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Ultrasound examination indicators included intestinal wall thickness, proximal bowel dilation, intestinal wall layer structure, Limberg grading, and the elasticity indicator SWE value. Patients were divided into inflammatory stricture group and fibrotic stricture group by using a modified fibrosis score of the narrowed intestine. Statistical analysis was performed to compare the differences in clinical data between the two groups, and Spearman correlation analysis was used to evaluate the correlation between ultrasound indicators and fibrosis score. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of SWE for inflammatory stricture and fibrotic stricture was calculated.Results:A total of 60 CD patients [44 men, 16 women; mean age, 34.3 ± 11.1 years; mean disease duration 60 (24, 117) months] were included. There were 43 patients in the inflammatory stricture group and 17 in the fibrotic stricture group. The differences in CRP ( P = 0.049), intestinal wall thickness ( P = 0.020), intestinal wall layer structure ( P = 0.001), and SWE value ( P < 0.001) between the two groups were statistically significant, but the differences in other indicators were not statistically significant (all P > 0.05). Intestinal wall thickness, intestinal wall layer structure, and SWE value were all positively correlated with fibrosis scores (all r s >0.3). In distinguishing inflammatory stricture from fibrotic stricture, a cut-off value of 15.9 kPa for SWE value yielded a sensitivity of 0.824, a specificity of 0.791, and the area under curve was 0.850 (95% CI: 0.740~0.952, P<0.001) . Conclusion:SWE examination can be used for the differential diagnosis of inflammatory and fibrotic strictures in CD, providing more diagnostic evidence for patients with stricture-type CD.

Objective:To assess the feasibility of shear wave elastography (SWE) in differentiating inflammatory and fibrotic strictures in Crohn's disease (CD) .Methods:A cross-sectional survey study was conducted. The patients with stricture-type CD who underwent SWE examination at the First Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2023 were continuously collected. The general data, laboratory examination indicators, and ultrasound examination indicators were collected. Laboratory examination indicators included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Ultrasound examination indicators included intestinal wall thickness, proximal bowel dilation, intestinal wall layer structure, Limberg grading, and the elasticity indicator SWE value. Patients were divided into inflammatory stricture group and fibrotic stricture group by using a modified fibrosis score of the narrowed intestine. Statistical analysis was performed to compare the differences in clinical data between the two groups, and Spearman correlation analysis was used to evaluate the correlation between ultrasound indicators and fibrosis score. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of SWE for inflammatory stricture and fibrotic stricture was calculated.Results:A total of 60 CD patients [44 men, 16 women; mean age, 34.3 ± 11.1 years; mean disease duration 60 (24, 117) months] were included. There were 43 patients in the inflammatory stricture group and 17 in the fibrotic stricture group. The differences in CRP ( P = 0.049), intestinal wall thickness ( P = 0.020), intestinal wall layer structure ( P = 0.001), and SWE value ( P < 0.001) between the two groups were statistically significant, but the differences in other indicators were not statistically significant (all P > 0.05). Intestinal wall thickness, intestinal wall layer structure, and SWE value were all positively correlated with fibrosis scores (all r s >0.3). In distinguishing inflammatory stricture from fibrotic stricture, a cut-off value of 15.9 kPa for SWE value yielded a sensitivity of 0.824, a specificity of 0.791, and the area under curve was 0.850 (95% CI: 0.740~0.952, P<0.001) . Conclusion:SWE examination can be used for the differential diagnosis of inflammatory and fibrotic strictures in CD, providing more diagnostic evidence for patients with stricture-type CD.

ObjectiveTo study the effect of Bushen Huoxuetang on the apoptosis and the expression of B-cell lymphoma （Bcl-2）-associated X protein （Bax）/ Bcl-2 and cleaved cysteine-containing aspartate proteolytic enzyme-3 （cleaved Caspase-3） in the nude mouse model of bone metastasis of breast cancer， and explore the mechanism of Bushen Huoxuetang in inhibiting bone destruction. MethodThirty BALB/c female nude mice were randomly assigned into blank group （n=6） and model group （n=24）. The suspension of 4T1 breast cancer cells was injected into the tibia of mouse right lower limb to establish model of bone metastasis of breast cancer. The successfully modeled nude mice were randomly assigned into model group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group， with 6 mice in each group. Bushen Huoxuetang was administrated at a dose of 36.67 g·kg^-1， once a day， and zoledronic acid was administrated by subcutaneous injection at a dose of 100 μg·kg^-1， twice a week. The combined drug group was administrated with the same doses of Bushen Huoxuetang group by gavage and zoledronic acid by subcutaneous injection. The mice in the blank group and the model group were administrated with the same volume of distilled water by gavage for 14 days. On the next day at the end of drug administration， the mice were sacrificed by cervical dislocation. The general situation and weight changes of the mice were examined. The right lower limb was collected， and X-ray scanning and hematoxylin-eosin （HE） staining methods were used for observation of pathological changes in the bone. The terminal deoxynucleotidyl transferase dUTP nick-end labeling （TUNEL） was employed to detect the apoptosis of bone tissue in nude mice， and Western blot to determine the expression of Bax/Bcl-2 and cleaved Caspase-3 in the bone tissue. ResultCompared with the blank group， the modeling reduced the body weight （P<0.01） and increased the right lower limb weight of the nude mice （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination increased the body weight （P<0.01） and decreased the right lower limb weight （P<0.01）. Compared with the blank group， the other groups showed obvious tumor cell atypia， deep nuclear staining， and clear bone metastasis， and the model group showed obvious osteolytic damage in right lower limb and loss of proximal tibia and knee joint. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination reduced the osteolytic lesions in the right lower limb and recovered part of the bone structure， demonstrating an inhibitory effect on bone destruction. The TUNEL assay showed that the model group had lower apoptosis rate of bone metastatic tumor cells than the blank group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group （P<0.01）. Compared with the blank group， the modeling down-regulated the expression of Bax and cleaved Caspase-3 （P<0.01） and up-regulated the expression of Bcl-2 （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination up-regulated the expression of Bax （P<0.01） and cleaved Caspase-3 （P<0.05， P<0.01） and down-regulated the expression of Bcl-2 （P<0.05， P<0.01）. ConclusionBushen Huoxuetang may inhibit bone destruction in the nude mouse model of bone metastasis of breast cancer by up-regulating the expression of Bax， down-regulating the expression of Bcl-2， activating cleaved Caspase-3， and further inducing apoptosis.

Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Objective To investigate the training methods and evaluation parameters for donor lung procurement technique in swine models. Methods The surgical skills of donor lung procurement in 15 swine models were summarized. The operation time, objective evaluation parameters before lung perfusion, gross observation after lung perfusion, the type and frequency of intraoperative errors were assessed. Results All donor lung procurement surgeries were successfully completed in 15 swine models. The mean time interval from skin incision to lung perfusion was 22.6 min. Prior to lung perfusion, the oxygenation index of the donor lung was (501±68) mmHg, (404±100) mL (under the pressure of 15 mmHg) for the tidal volume and (29±4) mL/cmH2O for the static compliance. Along with the increasing surgical frequency, the oxygenation index and tidal volume were improved. Favorable lung inflation was obtained after lung perfusion in a majority of swine models. Intraoperatively, multiple operating errors occurred including dissection error, pulmonary arterial intubation error and procedure error, etc. As the frequency of operation increased, the frequency of surgical errors was significantly decreased. Conclusions After certain training for donor lung procurement in swine models, the incidence of intraoperative procedure error is significantly reduced and the quality of the donor lung tends to be enhanced. Objective parameters, such as oxygenation index and the gross shape of the donor lung can be utilized to evaluate the levels of surgical techniques.

Objective How to improve nursing students′consciousness and ability of scientific research remains a big chal-lenge to in advanced nursing education .This study aimed to investigate the mode and methods of training the scientific research ability of adult nursing students in the junior-to-regular college education program . Methods Using a new mode of scientific research train-ing, i.e.class training+tutors′guidance+individual appraisal , we trained 242 adult nursing students from grades 2009 to 2013 of the junior-to-regular college education program , along with related questionnaire investigation . Results All the students considered the mode to be effective in improving their consciousness and ability of scientific research .During their study at school , they published 115 research papers in the Source Journals for Chinese Scientific and Technical Papers and Citations , and 18 of them undertook nursing re-search projects and won various awards for science and technology achievements in nursing research . Conclusion This new mode can effectively promote the scientific research ability of adult nursing students in the junior -to-regular college education program .

ObjectiveTo study the role of chemokines and their receptors in peripheral blood in the pathogenesis of breast cancer in elderly patients.MethodsSerum levels of regulated on activation normal T-cell expressed and secreted(RANTES),macrophage inflammatory protein-3 α (MIP-3α ) and stromal cell derived factor-1(SDF-1) were determined by double-antibody sandwich enzyme-linked immunosorbent assay(ELISA) in 30 elderly patients with breast cancer(breast cancer group) and 30 normal controls (control group).Meanwhile,chemokine receptors,CC chemokine receptor(CCR)5,CCR6 and CXC chemokine receptor(CXCR) 4 on peripheral blood CD3+ T-cell in two groups were analyzed by flow cytometry.ResultsSerum levels of RANTES,MIP-3 α and SDF-1 in breast cancer group were significantly higher than those in control group [ (27.9 ± 16.6) μ g/L vs.( 12.6 ± 4.2) μ g/L,( 10.9 ± 7.1 ) μ g/L vs.(5.4 ± 3.5 )μg/L,(339.4 ±94.6) ng/L vs. (195.0 ±70.8) ng/L,P ＜0.01].There was no significant difference in expressions of CCR5,CCR6 and CXCR4 on peripheral blood CD3+ T-cell between two groups(P ＞ 0.05).ConclusionThe abnormal increase of serum levels of RANTES,MIP-3 α and SDF-1 in peripheral blood may play role in the carcinogenesis and progress of breast cancer in elderly patients.

Objective To evaluate quantitatively perfusion in coronary microcirculation by transvenous myocardial contrast.echocardiography(MCE).Methods Transvenous MCE was performed before and after LAD stenosis in 12 dogs.Results Peak intensity and area under curve(AUC)in time-intensity curves were significantly decreased after LAD stenois,peak intensity and AUC were strongly related with CBF flow(peakintensity:r=0.9405～0.09666,P=0.0005～0.0001;AUC:r=0.8239～0.9761,P=0.0103～ 0.0056).Conclusion Transvenous MCE could quantitatively assess the perfusion in coronary microcirculation.