Objective:To explore the differences of gene expression profiles of precursors of exhausted T cells (Tpex) and terminal exhausted T cells (Tex) in the peripheral blood of patients with active pulmonary tuberculosis (ATB).Methods:Twenty-five cases of ATB, 13 cases of latent tuberculosis infection (LTBI) and 10 health controls were enrolled from January 2021 to October 2022 in the Fifth People′s Hospital of Wuxi. The proportions of Tpex and Tex in the peripheral blood mononuclear cells (PBMCs) of the three groups were detected by flowcytometry. PBMCs of ATB were separated into Tpex and Tex by fluorescence-activated cell sorting. RNA-sequencing was performed and up-regulated and down-regulated genes were screended. Differently expressed genes were analyzed by gene set enrichment analysis of gene ontology (GO) to find regulatory pathways affecting cell metabolism and function. Wilcoxon matched-pairs signed rank test, Kruskal-Wallis test and Dunn multiple comparsion test were used for statistical analysis.Results:The proportion of Tpex in ATB group was 2.86%(1.74%), which was lower than 7.93%(6.16%) of Tex, and the difference was statistically significant ( Z=-3.91, P<0.001). The proportions of Tpex and Tex in LTBI group were 9.47%(6.26%) and 7.43%(5.48%), respectively, and the difference was not statistically significant ( Z=-0.93, P=0.345). The proportions of Tpex and Tex in healthy control group were 8.42%(2.69%) and 6.49%(5.14%), respectively, with no statistical significance ( Z=-1.36, P=0.170). There was statistical difference of the proportion of Tpex among the three groups ( H=21.93, P<0.001), and the proportion of Tpex in ATB group was lower than those in LTBI and heathy control groups, and the differences were both statistically significant ( Z=4.16, P<0.001 and Z=3.34, P=0.003, respectively), while the proportions of Tex in these three groups were not statistically different ( H=2.17, P=0.338). Compared with Tex, the gene expressions of memory markers, such as B-cell lymphoma 2 of Tpex were up-regulated, and the gene expressions of exhausted markers, such as lymphocyte activation gene 3 were down-regulated. In terms of cellular metabolism, the gene expressions of mitochondrial protein complex, mitochondrial matrix and oxidative phosphorylation of Tpex were up-regulated, and the gene expressions of glycolysis were down-regulated. The gene expressions of pyruvate metabolism in Tex were up-regulated, and the gene expressions of CD4 + T lymphocyte activation and differentiation and glycolytic process in Tpex were down-regulated. Conclusions:Tpex in ATB express more characteristics of memory cells and less features of exhausted markers compared with Tex, and the function of mitochondria of Tpex preserves well.

The bony window technique refers to cutting the intact bone plate to form a bone window and a free bone block to get access to lesions under the bone. At the end of the surgery, the dislocated bony lid needs to be repositioned to its original position. In endodontic microsurgery, compared with conventional osteotomy, the bony window technique has the advantages of improving the view of surgery and operability, reducing postoperative bone defects, promoting bone healing, and maintaining the integrity of the jaw outline. Accurate positioning and preparation of the bony window are important prerequisites for subsequent operations during the surgery, but it′s difficult in some situations, such as when the operative area is located posteriorly or the bone cortex on the lesion surface is thick and intact. What′s more, whether the free bone block can be stabilized in situ after repositioning is closely related to the prognosis of the surgery. The complementary application of digital navigation technology and bone cavity filling materials may help to improve the bony window technique and provide more possibilities for the retention of affected teeth in difficult cases.

Objective:To explore the competitive attitude of students of medical college and its influencing factors.Methods:A sample of 382 first to third year medical students was selected with the method of random sampling. The questionnaire consists of three parts: demographics, Competitive Attitude Scale of Chinese Version and Jefferson Scale of Physician Empathy. SPSS 25.0 was applied to perform the statistical analysis. Concrete methods that used involved statistical interpretation, Kruskal-Wallis test, Mann-Whitney U test and Spearman rank sum correlation analysis. Results:The benign competitive attitude of students was 51.00(45.00，56.00) and the excessive competitive attitude was 35.00(31.00，38.00). There was a statistically significant difference in the score of benign competitive attitude among medical students of different grades( H=22.31, P<0.001). There were statistically significant differences in the scores of benign competitive attitudes among the medical students who enjoy teamwork ( Z=-4.53, P<0.001), who had role models to follow in the medical field ( Z=-3.99, P<0.001), and who had careful career planning ( Z=-2.19, P=0.029). There were statistically significant differences in the scores of excessive competitive attitudes among the medical students who enjoy teamwork ( Z=-2.47, P=0.014), who had role models to follow in the medical field ( Z=-2.89, P=0.004), and who had careful career planning ( Z=-2.32, P=0.021). There was a weak positive correlation between empathy and benign competitive attitude ( r=0.20, P<0.001), but a negative correlation between empathy and excessive attitude ( r=-0.36, P<0.001). Conclusions:Medical students had a good competitive attitude. Medical college should pay more attention to improving medical students' sense of teamwork, career planning ability and willingness to learn from role models, guide students to develop a benign competitive attitude and focus on improving their professional quality.

Toxoplasma gondii(T.gondii or Tg),is an obligatory intracellular parasite with humans as its intermediate hosts.In recent years,significant correlations between T.gondii infection and schizophrenia have been reported,including the possible mediating mechanisms.Currently,mechanisms and hypotheses focus on central neurotransmitters,immunity,neuroinflammation,and epigenetics;however,the exact underlying mechanisms remain unclear.In this article,we review the studies related to T.gondii infection and schizophrenia,particularly the latest research progress.Research on dopamine(DA)and other neurotransmitters,the blood-brain barrier,inflammatory factors,disease heterogeneity,and other confounders is also discussed.In addition,we also summarized the results of some new epidemiological investigations.

Consumptive thirst such as dry mouth and polydipsia,frequent urination polyuria,fear of heat and hyperhidrosis and loss of other body fluids,yin deficiency and internal heat expression,and irritability and other abnormal emotional symptoms are common.The Synopsis of Golden Chamber need to be further explored for the treatment of miscellaneous diseases.The dialectical thought has a high clinical application value.Lily disease treatment recommendations in the Synopsis of Golden Chamber are explored.The symptoms of lily disease are varied and uncertain,which are caused by the scattering and wandering aimlessly of heat pathogen.The pathogenesis of lily disease can be examined through external symptoms such as bitter taste in mouth,red urine,and faint and rapid pulse.Diabetes is also closely related to yin deficiency and internal heat,and the pathogenesis of the two is similar.Mental symptoms are common characteristics of lily disease and diabetes.The method taken from the Synopsis of Golden Chamber and Baihe-like prescriptions for the treatment of diabetes are effective.By identifying different patterns,symptoms,and indicators,we can select lily bulb,common anemarrhena,rhizome,figwort root,unprocessed rehmannia root,and other drugs to treat diabetes,in order to improve our understanding of lily disease and provide new ideas for diabetes treatment.

Objective To explore the feasibility of predicting expression level of Ki-67 in lung adenocarcinoma via multi-parameter of spectral CT.Methods The data of 226 patients with lung adenocarcinoma confirmed by pathology were analyzed retrospectively.The conventional and spectral CT parameters of the lesions were analyzed.According to Ki-67 expression level,all patients were divided into low expression group and high expression group.The parameters with statistical significance were identified as independent variables for multivariate logistic regression analysis to establish a logistic regression model for predicting the expression level of Ki-67.Receiver operating characteristic(ROC)curve was used to assess the diagnostic performance for each model,respectively.Results There were significant differences in the clinical factors of gender,smoking and chest pain between high and low Ki-67 expression groups.In spectral CT parameters,CT40 keV,CT100 keV,Z-effective(Zeff)and iodine concentration(IC)in the high expression group in arterial phase were significantly higher than those in the low expression group.Logistic regression analysis showed that CT100 keV was the independent risk factor for Ki-67 expression level.Both the spectral CT model and the combined model had high value in predicting the expression level of Ki-67 in lung adenocarcinoma,and the combined model had better diagnostic efficacy.Conclusion Spectral CT parameters combined with clinical factors have a certain value in predicting the expression level of Ki-67 in lung adenocarcinoma.

Innate immune response is the first line of immune defense in our body against invaded pathogens.After receive pathogen stimulation,immune cells synthesize abundant type Ⅰ interferons(IFNs)through activating three different signaling path-ways to establish strong antiviral immune response.Mounting evidences have revealed that selective autophagy participates in the regu-lation of innate type Ⅰ IFN response and prevents the excessive activation of immune responses.E3 ubiquitin ligases transfer different type of polyubiquitin chains to some key signaling proteins,and trigger the selective degradation of these proteins through autophago-some-lysosome pathway.Therefore,autophagy and E3 ubiquitin ligases integrate the spatiotemporal regulation of innate type Ⅰ IFN response.In this review,we summarized current data elucidating the critical role of autophagy and E3 ubiquitin ligases in the regula-tion of innate immune response.

The mutual recognition of medical examination results is significant for improving the utilization efficiency of limited resources in large public hospitals,promoting the sharing of quality medical resources,alleviating the high costs and diffi-culties of healthcare for the public,reducing pressure on medical insurance funds,and enhancing the efficiency of fund utiliza-tion.This study reviews the research on mutual recognition of medical examination results in China,analyzing it from four as-pects:regulatory norms,platform construction,policy awareness,and performance distribution.It identifies research hotspots and directions related to mutual recognition,clarifies the challenges and key points in the implementation of relevant policies,and suggests future research directions,including strengthening theoretical research,improving empirical studies,and innovating re-search methods.

Background::Substantial progress in air pollution control has brought considerable health benefits in China, but little is known about the spatio-temporal trends of economic burden from air pollution. This study aimed to explore their spatio-temporal features of disease burden from air pollution in China to provide policy recommendations for efficiently reducing the air pollution and related disease burden in an era of a growing economy.Methods::Using the Global Burden of Disease method and willingness to pay method, we estimated fine particulate matter (PM 2.5) and/or ozone (O 3) related premature mortality and its economic burden across China, and explored their spatio-temporal trends between 2005 and 2017. Results::In 2017, we estimated that the premature mortality and economic burden related to the two pollutants were RMB 0.94 million (68.49 per 100,000) and 1170.31 billion yuan (1.41% of the national gross domestic product [GDP]), respectively. From 2005 to 2017, the total premature mortality was decreasing with the air quality improvement, but the economic burden was increasing along with the economic growth. And the economic growth has contributed more to the growth of economic costs than the economic burden decrease brought by the air quality improvement. The premature mortality and economic burden from O 3 in the total loss from the two pollutants was substantially lower than that of PM 2.5, but it was rapidly growing. The O 3-contribution was highest in the Yangtze River Delta region, the Fen-Wei Plain region, and some western regions. The proportion of economic burden from PM 2.5 and O 3 to GDP significantly declined from 2005 to 2017 and showed a decreasing trend pattern from northeast to southwest. Conclusion::The disease burden from O 3 is lower than that of PM 2.5, the O 3-contribution has a significantly increasing trend with the growth of economy and O 3 concentration.

Objective:To evaluate the clinical efficacy and safety of endoscopic ultrasound (EUS)-guided coil implantation combined with glue injection for preventing rebleeding of tumorous gastric fundal varices.Methods:A retrospective analysis was performed on the clinical data of patients who underwent EUS-guided coil implantation combined with glue injection due to tumorous gastric fundal variceal bleeding from September 2017 to December 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The basic characteristics and endoscopic manifestations of patients treated with this technique were analyzed, and the success rate of this technique, the usage of tissue glue and coil, the variceal obliteration rate and the incidence of complications such as pulmonary embolism were analyzed. Patients were followed up over a long period of time to obtain data on rebleeding. At the same time, patients were divided into complete obliteration group and incomplete obliteration group according to the endoscopic performance after the treatment, and the rebleeding rate in the two groups was compared.Results:Among the 41 patients included in this study, 18 cases (43.90%) had single isolated gastric varices type 1, and 23 cases (56.10%) had gastroesophageal varices combined. Fourteen cases had signs of recent bleeding such as thrombi and ulcers under endoscopy, and 13 cases had combined portal hypertensive gastropathy. All patients successfully completed the operation of EUS-guided coil implantation combined with glue injection. The technical success rate for the first attempt was 92.68% (38/41). The one-time pre-installation success rate of coils was 95.12% (39/41). The success rate of target vessel aspiration under EUS guidance was 100.00% (41/41). The release success rate of coil was 97.56% (40/41). The number of coils used was 1.12±0.33, and the amount of tissue glue used after inserting the coils was 1.54±0.46 mL. The target vessel obliteration rate after operation was 97.56% (40/41), and the complete gastric fundal variceal obliteration rate was 51.22% (21/41). There were 2 cases (4.88%) of intraoperative bleeding, 1 case stopped spontaneously, and 1 case successfully stopped bleeding after additional injection of tissue glue under direct endoscopic vision. No patient had symptoms of pulmonary embolism such as decreased oxygen saturation during the operation. Postoperative computed tomography angiography of pulmonary artery or lung computed tomography was performed in 24 cases, of which 1 case (4.17%) showed distal pulmonary artery embolism, but there were no relevant clinical manifestations. The patients were followed up for 21.64±16.86 months (1-50 months) after the surgery. There were 13 cases (31.71%) of recurrent gastrointestinal bleeding after the surgery, no rebleeding within 5 days, 2 cases of rebleeding within 3 months, 5 cases from 3 to 12 months, and 6 cases more than 1 year. Among the 13 cases of recurrent bleeding after the surgery, the recurrence rate of bleeding after operation in the complete obliteration group was 23.81% (5/21), which was lower than that in the incomplete obliteration group with 40.00% (8/20), but there was no statistically significant difference ( χ2=1.240, P=0.265). Conclusion:EUS-guided coil implantation combined with glue injection has good secondary prevention value and safety for tumorous gastric fundal variceal bleeding, and is worthy of clinical promotion and application.