ObjectiveThe U6 promoter is an essential element for driving sgRNA expression in the clustered regularly interspaced short palindromic repeat sequences/CRISPR-associated protein 9（CRISPR/Cas9）gene editing system in dicotyledonous plants. Endogenous U6 promoters typically exhibit higher transcriptional activity， which can significantly improve gene editing efficiency. This study aims to identify endogenous U6 promoters in Artemisia annua to optimize its CRISPR/Cas9 gene editing system， which holds significant importance for its molecular breeding. MethodsOn the basis of the highly conserved U6 snRNA sequences in Arabidopsis thaliana， endogenous U6 promoters were screened in the A. annua genome. Expression vectors were constructed with candidate AaU6 promoter driving the firefly luciferase （LUC） reporter gene， and then transiently transformed into Nicotiana benthamiana. Transcriptional activities of the promoters were measured and compared by in vivo imaging and the Dual Luciferase Reporter assay. ResultsEight endogenous U6 promoters were successfully cloned from A. annua. Sequences alignment revealed that all these promoters contained the two conserved cis-acting elements， upstream sequence element （USE） and TATA-box， which affected their transcriptional activity. Dual-luciferase activity assays indicated that the transcriptional activities of AaU6-3， AaU6-1， and AaU6-5 were significantly higher than that of the Arabidopsis AtU6-26 promoter， with AaU6-3 exhibiting the highest activity. ConclusionThis study identified three endogenous AaU6 promoters with high transcriptional activity in A. annua， providing key functional elements for establishing an efficient gene editing system in A. annua. These findings will contribute to advancing precision molecular breeding and high-quality germplasm innovation in A. annua.

Early identification and intervention of high-risk factors during pregnancy is important for the prevention of maternal mortality. A certain hospital has established a management system for pregnant women undergoing first visit in non-obstetric departments and started applying it in three campus of the hospital in July 2023. Through the information management module for pregnant women undergoing first visit in non-obstetric departments that embedded in the hospital information system, abnormal pregnancy situations could be screened in a timely, comprehensive, and standardized manner, and quality control management could be carried out. At the same time, the hospital established a graded management path based on the severity of the condition of pregnant women, and provided early intervention for critically ill pregnant women reported through standardized management and multidisciplinary collaboration. From July to December 2023, a total of 5 766 pregnant women were first diagnosed and reported in 41 non-obstetric departments. Telephone follow-up showed a true reporting rate of 93.0%, and a total of 11 critical illness case were reported, including 2 cases of misoperation, with an accuracy rate of 81.8%. There were no adverse outcomes caused by failure to detect critical illness cases in a timely manner. In contrast, the relevant statistical data from January to June 2023 showed that there were 257 cases of pregnant women reported by non-obstetric departments, including 0 cases of critical illness and 1 case of missed critical illness. In addition, the time for non-obstetricians to screen for critically illness pregnant women of childbearing age has been reduced from 5-10 min per person before the system application to 15 s-1 min per person. The application of this system has reduced the missed reporting of critical illnesses, effectively ensured the safety of pregnant women, and improved work efficiency. It can provide reference for safety management of pregnant women in other medical institutions.

Objective:To investigate the changes in liver injury and oxidative-antioxidant level in mice exposed to X-rays at varying doses.Methods:Fifty-four 8-week-old male C57BL/6J mice were divided into three groups, namely the control, 2 Gy irradiation, and 4 Gy irradiation groups. Then, each of the groups was further divided by days post-irradiation (i.e., 1, 3, and 7 d), and so nine sub-groups ( n = 6). After irradiation was performed as planned, all the mice were dissected and weighed, and their liver indexes were calculated to determine any histopathological changes in the liver. The peripheral blood cell count and the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were detected. Furthermore, spectrophotometry was also used to determine the superoxide dismutase (SOD) activity, the malondialdehyde (MDA) concentration, and the reduced glutathione (GSH) concentration in liver tissues. Results:Compared to the control group, mice undergoing irradiation exhibited a significant reduction in body weight ( F = 84.03, 27.11, 25.50, P < 0.001), but significantly increased liver indexes ( F = 28.40, 17.75, P <0.001) at 1, 3, and 7 d post-irradiation. Pathological observations of these mice revealed liver injury, which proved related to dose and time course. The counts of leukocytes, neutrophils, and lymphocytes in peripheral blood decreased significantly ( F = 8.42-22.91, P < 0.05), trending downward with an increase in the radiation dose. For mice in the 4 Gy irradiation group, their AST and ALT levels increased significantly at 1 d post-irradiation ( H = 7.24, 7.82, P < 0.05), and their ALP levels rose notably at 1 and 3 d post-irradiation ( F = 11.86, 9.75, P < 0.05). Furthermore, their MDA and SOD levels initially rose and then dropped but their GSH levels exhibited an opposite trend at 1, 3, and 7 d post-irradiation. There was a positive correlation between their MDA levels in the liver and the degree of damage to histopathological lesions at 1, 3, and 7 d post-irradiation ( r = 0.30, P < 0.001). Conclusions:A model for radiation-induced liver injury of mice was preliminarily established in this study. It can be concluded that X-rays at varying doses affect the severity of liver injury, pathological grade, peripheral blood cell count, liver function index, and liver oxidative and antioxidant levels of mice, presenting a certain relationship between dose and time course effects.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

In this study, the virtual simulation tutoring system was applied to the teaching of dental residents in the standardized training stage for the first time, including the curriculum preparation, curriculum design and teaching practice. Through the practice of the preparation of class Ⅱ holes and the tooth preparation of PFM (porcelain fused to metal) by the dental residents in the virtual simulation teaching system, the teaching arrangement of three courses as one term was explored. Each course adopted the matching interactive teaching mode. Finally, the transcripts would be given by the virtual simulation teaching system to comment and summarize. This study has laid a foundation for future promotion of virtual simulation teaching system in the standardized training stage of stomatology residents and found a new direction for improving the proficiency and accuracy of residents' clinical operation skills.

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective To compare the effects of mizolastine intensive dose and mizolastine conventional dose+momestasone furoate on symptom score and laboratory index of patients with allergic rhinitis caused by pollen allergy.Methods From June 2016 to January 2018,one hundred and fifty allergic rhinitis patients caused by pollen allergy were chosen in the First People＇s Hospital of Taizhou and randomly divided into two groups according to the digital table,with 75 patients in each group.A group was treated with mizolastine intensive dose scheme,and B group was treated with mizolastine conventional dose +momestasone furoate. The short -term efficacy,rhinitis symptoms score,the levels of histamine,leukotrienes C4,IL-6,IL-8 and TNF-α before and after treatment,the incidence of adverse reactions and daily treatment cost of the two groups were compared.Results The short-term efficacy of B group was significantly better than that of A group(93.33% vs.81.33% ,χ2 =9.15,P<0.05).The rhinitis symptoms scores of B group[(0.49 ± 0.19)points,(1.02 ± 0.20) points,(0.95 ± 0.28) points,(0.84 ± 0.20)points] after treatment were significantly lower than those of A group [(0.87 ± 0.21) points,(1.40 ± 0.24) points,(1.63 ± 0.36)points,(1.19 ± 0.27) points] and before treatment[(3.13 ± 1.06) points,(2.88 ± 0.57) points,(2.81 ± 0.79)points,(2.85 ± 0.61)points](t=2.45,2.71,2.66,2.89,3.78,3.75,3.44,4.53,all P<0.05).The levels of histamine,leukotrienes C4,IL-6,IL-8 and TNF-α of B group[(15.76 ± 3.54) mg/L,(12.17 ± 3.58) mg/L, (1.23 ± 0.19)mg/L,(3.27 ± 0.62)mg/L,(3.96 ± 1.05)mg/L] after treatment were significantly lower than those of A group [(19.58 ± 5.25) mg/L,(15.44 ± 4.14) mg/L,(1.96 ± 0.33)mg/L,(5.40 ± 0.88) mg/L,(5.01 ± 1.40)mg/L] and before treatment[(24.57 ± 7.67) mg/L,(18.90 ± 6.33) mg/L,(2.58 ± 0.54) mg/L,(7.66 ± 1.17)mg/L,(6.81 ± 1.67)mg/L](t=2.31,2.50,2.53,2.39,3.05,3.60,3.10,3.57,3.90,all P<0.05).There was no statistically significant difference in the incidence rate of adverse reactions between the two groups ( P >0.05).The daily treatment cost of B group after treatment was significantly less than that of A group and before treatment[(7.56 ± 1.02)CNY vs.(6.88 ± 0.80)CNY,t=3.12,P<0.05].Conclusion Compared with mizolas-tine intensive dose scheme,mizolastine conventional dose + momestasone furoate in the treatment of patients with allergic rhinitis caused by pollen allergy can efficiently relieve the nasal symptoms, down - regulate the levels of histamine,leukotriene C4 and inflammatory cytokines,reduce the treatment cost and has the approved safety.

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopicassistant plate-screw fixation ofsyndesmosis.Methods From January 2015 to December 2016,totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People's Hospital.Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury.Another 11 patients in the control group were performed a classic syndesmosis screw fixation.Plain radiographic examination was carried out during the follow-up.Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS).A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month.Results The patients were followed for an average 18 months (range from 12 to 24 months)except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group.The implants of syndesmosis were removed at 12th week post-operatively.No cases of re-diastasis occurred during the follow-up.There was significant difference with in the groups.In the MIS group,the AOFAS ankle hindfoot score was (85.9 ±4.1) points at 6th month post-operatively,and increased to (90.8 ± 3.7) at 12th month (P ＜ 0.05).VAS score was (2.4 ± 1.2) at 6th month and (1.1 ± 0.7) at 12th month after the operation(P ＜0.05).In the control group,the AOFAS ankle hindfoot score was (81.1 ±4.7) points at 6th month after operation,and increased to (89.1 ± 3.4) at 12th month after operation (P ＜ 0.05).VAS score was (3.2 ± 1.3) at the 6th month and (1.0 ± 1.0) at the 12th month after operation (P ＜ 0.05).However,for the outcome comparison between the two groups,only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P ＜ 0.05),other results,had no significant difference.Nocomplications of implant failure,nonunion,malunion or post-traumatic arthritis were occurred during the followup.Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation,which is a safe and effective surgical method.