Folic acid is a fully oxidized synthetic folate with high bioavailability and stability which has been extensively prescribed to prevent congenital disabilities. Here we revealed the immunosuppressive effect of folic acid by targeting splenic marginal zone B (MZB) cells. Folic acid demonstrates avid binding with the Fc domain of immunoglobulin M (IgM), targeting IgM positive MZB cells in vivo to destabilize IgM-B cell receptor (BCR) complex and block immune responses. The induced anergy of MZB cells by folic acid provides an immunological escaping window for antigens. Covalent conjugation of folic acid with therapeutic proteins and antibodies induces immunological evasion to mitigate the production of anti-drug antibodies, which is a major obstacle to the long-term treatment of biologics by reducing curative effects and/or causing adverse reactions. Folic acid acts as a safe and effective immunosuppressant via IgM-mediated MZB cells targeting to boost the clinical outcomes of biologics by inhibiting the production of anti-drug antibodies, and also holds the potential to treat other indications that adverse immune responses need to be transiently shut off.

Objective:To investigate the value of flattening filter-free (FFF) mode in postoperative deep inspiration breath-hold (DIBH) intensigy-modulated radiotherapy for left breast cancer.Methods:A retrospective case series study was conducted. Clinical data of 21 patients with left breast cancer who underwent DIBH intensity-modulated radiotherapy after modified radical surgery in Meizhou People's Hospital from January 2021 to December 2022 were retrospectively analyzed. On the DIBH-mode CT of each patient, the 7-field intensity-modulation plan was designed using the plan developed in the 6 MV FFF-mode (FFF group) or the plan developed in the 6 MV flattening filter (FF)-mode (FF group). The target areas and organs at risk, dosimetric and biological parameters, and dose validation results were compared between the two plans.Results:Twenty-one patients were female with the age [ M ( Q1, Q3)] of 47 years old (32 years old, 61 years old). The percentage of target areas receiving 95% of the prescribed dose (V 95%) was (95.9±0.8)% and (95.7±1.9)% in the FF and FFF groups ( t = 2.98, P = 0.089), and the maximum dose was (5 401±251) cGy and (5 424±201) cGy ( t = 2.85, P = 0.181), the fitness indices were 0.88±0.05 and 0.87±0.06 ( t = 0.32, P = 0.562), the homogeneity indices were 1.06±0.01 and 1.07±0.02 ( t = 2.91, P = 0.009), the equivalent uniform doses (EUD) were (51.81±0.21) Gy and (51.97±0.20) Gy ( t = 0.51, P = 0.309), and the tumor control probability (TCP) was (99.68±0.01)% and (99.61±0.02)% ( t = 0.81, P = 0.560). The plans of the FFF group and the FF group were compliant, and the doses of all organs at risk to be irradiated were within the clinically acceptable range, and the radiation doses in the FFF group in the left lung [5 Gy irradiated volume (V 5 Gy), mean dose (D mean), EUD and normal tissue complication rate (NTCP)], right lung (V 5 Gy and D mean), heart (V 10 Gy, D mean, EUD and NTCP), and right breast (V 5 Gy, D mean and EUD) were differently lower than those in the FF group, and the differences were statistically significant (all P < 0.05). The monitor units in the FFF and FF groups were (984±132) MU and (751±145) MU ( t = -1.25, P < 0.001), and the total beam-on time was (1.4±0.3) min and (2.2±0.4) min ( t = 0.68, P < 0.001); individual field beam-on time was (12±7) s and (16±10) s ( t = 2.68, P = 0.001), and the beam-on time for each field in patients of the FFF group was less than 25 s; γ pass rates were (97.1±2.8)% and (97.6±2.1)% ( t = 0.59, P = 0.484). Conclusions:In the intensity-modulated radiotherapy of left breast cancer, the radiation dose of the energy to the critical organs in FFF mode is lower and has higher dose rate and shorter treatment time. FFF combined with DIBH technique has positive clinical significance in the intensity-modulated radiotherapy of breast cancer.

Specific pathogen-free(SPF)chickens are widely used in the research of avian diseases and vaccines.Vertically transmissible diseases are transmitted to chickens through vertical transmission,seriously affecting their survival rate,increasing production costs,and causing significant economic losses to the poultry industry,while severely impacting the breeding and use of SPF chickens.Therefore,it is crucial for researchers and managers to enhance their understanding of vertically transmissible pathogens in chickens and to develop effective monitoring measures.Quality monitoring is an important part of ensuring the quality of SPF chickens,with pathogen detection being the primary step.Based on this,it is necessary to cultivate qualified SPF chickens through purification methods and biosecurity measures.This paper reviews the major vertically transmissible pathogens in chickens,including viral pathogens,bacterial pathogens and mycoplasmas,as well as their detection methods.This study compares the differences in microbiological testing items and methods for SPF chickens between the U.S.corporate standard and the Chinese national standard.Analysis of the results shows that in both standards,vertically transmissible pathogens such as Escherichia coli,Proteus mirabilis,Salmonella,and avian leukosis are not included in the microbiological testing items for SPF chickens.Instead,these pathogens are characterized by mixed infections,and outbreaks can seriously affect flock health.To produce higher-quality SPF chickens,it is necessary to include these pathogens in the mandatory testing items.The aim of this paper is to help readers understand the relevant standards for microbiological monitoring of SPF chickens,the hazards of vertically transmissible pathogens,and prevention and control strategies,so as to provide a reference for the detection and purification of pathogens in SPF chickens.

Objective To explore the relationship of the preoperative serum alanine aminotransferase(ALT)/aspartate aminotransferase(AST)ratio and imaging features to the prognosis of patients with hepatocellular carcinoma(HCC)after receiving transarterial chemoembolization(TACE),and to develop a nomogram model used for predicting the patient's overall survival(OS).Methods A total of 211 patients,who were diagnosed as HCC and were treated with TACE as the initial therapy at the Guangci Branch of the First Affiliated Hospital of Soochow University of China between July 2016 and July 2020,were enrolled in this study.The patients were randomly divided into the modeling group(n=139)and validation group(n=72).The receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of AST/ALT ratio.The univariate and multivariate Cox regression analyses were conducted in the modeling group to screen out the independent predictors affecting HCC patient's OS and to establish a prognostic model.Harrell consistency index(C-index)was used to evaluate the predictive ability of the nomogram model for OS in HCC patients,and the calibration curves were plotted to assess the predictive accuracy of the nomogram model.Results No statistically significant difference in the baseline feature distribution existed between the modeling group and validation group(P＞0.05).The median OS of the modeling group and validation group was 28.5 months(95％CI:22.1-34.9)and 25.1 months(95％CI:19.2-29.0)respectively,the difference was not statistically significant(x2=1.395,P=0.322).The optimal cutoff value of AST/ALT ratio for predicting OS was 1.10,and the area under curve(AUC)value was 0.674(95％CI:0.604-0.753).The Cox regression analysis indicated that the tumor number(HR=2.080,95％CI=1.245-3.475,P=0.005),tumor capsule(HR=1.771,95％CI=1.128-2.780,P=0.013),irregular marginal enhancement(HR=1.884,95％CI=1.190-2.984,P=0.007),and AST/ALT ratio(HR=2.450,95％CI=1.506-3.987,P＜0.01)were the independent prognostic factors for HCC patients receiving TACE treatment.Based on the above variables,a nomogram model for predicting OS was established,and the C-index values in the modeling group and validation group were 0.733(95％CI:0.650-0.826)and 0.770(95％CI:0.688-0.862)respectively.The calibration curves showed that no significant deviations existed between the predictive curves of the prognostic model and the ideal reference curves for one-,2-and 3-year OS.Conclusion The nomogram model,which is established based on the tumor number,imaging features and preoperative AST/ALT ratio,has an excellent value in predicting the prognosis of HCC patients treated with TACE.

Medical postgraduates are the new force of scientific research groups in China. However, the limitation of their English language ability restricts their publication of high-level Science Citation Index (SCI) papers to a large extent. Measures to improve students’ SCI language ability from macro, intermediate and micro aspects were discussed through flipped classroom teaching mode, such as students’ reading papers before class, students’ practicing paper writing after class, and teacher’s making comments in class. The feedback from the questionnaire showed that 96.65% of the students were satisfied with the teaching mode and 93.57% of them had improved their confidence in SCI writing. For the problems mentioned in the feedback, it was suggested that colleges and universities should formulate policies to encourage teachers to engage in medical English teaching, meanwhile teachers should constantly improve their professional quality, so as to help students improve their SCI language ability rapidly.

Severe liver disease during pregnancy is uncommon in clinical practice. The most common cause of liver disease during pregnancy is liver dysfunction, with an overall prevalence rate of approximately 3%. Liver disease during pregnancy is classified into the liver diseases directly caused by pregnancy and those co-existing with pregnancy, i.e., pre-existing liver disease or occasional liver disease during pregnancy. A differential diagnosis of pre-existing and co-existing liver diseases may help to improve maternal and fetal outcome. During clinical diagnosis and selection of treatment and intervention measures, priority should be given to the potential impact on mother and fetus. This article introduces the latest research advances in the general information, pathogenesis, treatment, and pregnancy outcome of major liver diseases during pregnancy and elaborates on the risk of pregnancy and related coping measures for patients with pre-existing liver disease, so as to guide clinical diagnosis and treatment and patient management.

Objective To investigate the effect of early early enteral nutrition combined with parenteral nutrition support on postoperative gastrointestinal function,nutritional status and liver function of patients with obstructive jaundice.Methods Sixty-two patients with obstructive jaundice of hepatobiliary who were treated in the General Surgery Department of the Affiliated Hospital of North China University of Science and Technology from July 2013 to July 2014 were randomly divided into the control group and the observation group,31 cases in each group.The control group were treated with simple parenteral nutrition,and were injected by central venous catheter at the first day after operation,with the injection tiem of 12-15 h and continuous infusion of 7 d or more.The observation group were received enteral nutrition combined with parenteral nutrition,parenteral nutrition was given first,and the preparation method of the nutrient solution was identical with that of the control group;and then slowly dropped 250 ml physiological saline into the jejunum nutrition tube at the second day,dropped into the enteral nutrition liquid at the third day with the initial dose of 300 to 500 ml per day,slowly dropped in the speed of 20-30 ml/h.Results The first exhaust time,first defecation time and hospitalization time in the observation group were (41.37±6.85) h,(46.85±7.13) h and (12.79±3.76) d,significantly shorter than those in the control group ((57.21 ± 9.23) h,(61.43 ± 10.62) h and (16.94 ± 4.33) d;t =7.67,6.35,4.03;P＜O.05),daily hospitalization expenses was (1637.65± 138.24)yuan,significantly less than that in the control group((2121.42±112.38)yuan;t=15.12;P＜0.05).The serum albumin berofe and after the operation in the control group and observation group were (28.73±3.24) g/L and (29.21±3.31) g/L,(36.85±4.05) g/L and (47.21±4.13) g/L,respectively.The serum pre albumin berofe and after the operation in the control group and observation group were (162.81±31.27) g/L and (163.14±30.56) g/L,(248.95±58.62) g/L and(324.24±61.34) g/L,respectively.There was no difference before operation between the two groups (P＞0.05),while the serum protein levels were significantly increased in observation group than the control group (P＜0.01).There were no difference in ALT,total bilirubin and direct bilirubin levels between the two groups before operation (P ＞ 0.05),after treatment,the levels of ALT,total bilirubin and direct bilirubin in the observation group were significantly higher than those in the control group(P＜0.01).The patients in the two groups recovered well,and no serious adverse reactions occurred.Conclusion Early enteral and parenteral nutrition support in patients with obstructive jaundice has better effect and safety in the clinical treatment.

Objective To investigate the expression change of RACK1 ,Src and Bcl‐2 in gastric carcinoma tissue and adjacent carcinomatous tissue .Methods Eighty specimens of gastric carcinoma and adjacent carcinomatous tissues in our hospital from Au‐gust 1 ,2011 to February 1 ,2014 were collected .The immunohistochemistry staining and Western blotting methods were adopted to detect the expression of RACK1 ,Src and Bcl‐2 protein in gastric carcinoma and adjacent carcinomatous tissues ,and their correlation was analyzed and performed the statistical analysis by combining with the clinicopathological data .Results The immunohistochem‐istry staining and Western blotting detection displayed that the expression positive rate and expression level of RACK 1 in gastric carcinoma tissue were obviously lower than those in the adjacent carcinomatous tissue ,while the expression positive rate and ex‐pression level of Src and Bcl‐2 in gastric carcinoma tissue were obviously higher than those in the adjacent carcinomatous tissue ,the differences were statistically significant (P<0 .05) .The RACK1 expression in gastric carcinoma tissue was negatively correlated with the Src and Bcl‐2 expression(r= -0 .632 ,-0 .754 ,P<0 .01) ,while Src had no obvious correlation with Bcl‐2 protein(r=0 .217 ,P>0 .05) .Conclusion The expression of RACK1 in gastric carcinoma tissue is significantly decreased ,while the expres‐sions of Src and Bcl‐2 are increased .

Objective To distinguish the increase of white blood cells after glucocorticoid is the adverse reaction of glucocor‐ticoid or infection aggravated .If we can analyse it properly ,the abuse of antimicrobials and waste of medical could be avoid re‐source .Methods 74 patients which were in our hospital from 2011 .1 to 2012 .12 were recruited into this study .They were divided into three groups ,including non‐infection with glucocorticoid(n=15) ,infection without glucocorticoid(n=29) and infection with glucocorticoid(n=30) according to disease and therapies .After being treated 0 day ,3 days ,7 days ,venous blood of patients were collected to detect white blood count ,CRP and morphology of leukocyte .Results The group of non‐infection with glucocorticoid applied glucocorticoid after 3 days and 7days ,WBC was increased significantly(P<0 .01 ,respectively) .And compare with the group of infection without glucocorticoid ,more band neutrophils could be seen in peripheral blood smear of the other two(P< 0 .05) . While there was no difference on level of CRP between the groups of infection without glucocorticoid and infection with glucocorti‐coid(P>0 .05) .Conclusion Glucocorticoid rise the count of WBC in peripheral blood especially the neutrophil .We can evaluate in‐fectious status by the level of CRP and the count of band neutrophils in peripheral blood smear .

Objective To evaluate the role of several traditional laboratory examinations in identifying the cause of WBC count increase,which might be the adverse reaction of glucocorticoid or infection.Methods 74 patients treated in the hospital from Jan. 2011 to Dec.2012 were recruited in the study.Glucocorticoid without Infection(n =15 ),Infection without Glucocorticoid(n =29) and Infection with Glucocorticoid(n=30)Group were devided according to the type of disease and therapies.After being treated for 0,3,7 d,respectively venous blood samples of patients were collected to determine the concentration of CRP,WBC count,leukocyte classification and NAP score.CRP was used as the Judgment index for the degree of infection,the changes of other indexes were compared.Results Compared with the Infection without Glucocorticoid Group,the CRP concentration of the Infection with Glu-cocorcoid Group was becoming lower(P >0.05).The Non-infection with Glucocorticoid Group applied glucocorticoid for 3 days and 7 days respectively,the count of neutrophilic granulocyte and NAP score increased significantly compared with that before glucocor-ticoid application(P <0.01)while the count of lymphocyte reduced(P <0.05)and no significant change in the count of eosnophils (P >0.05).Conclusion The increase of WBC after glucocorticoid can not be identified whether it is the adverse reaction of glu-cocorticoid or aggravated infection by using classification of leukocyte,the increasing amount of WBC and NAP score.