浙江省中医院构建中医药特色门诊服务实践及体会

浙江省中医院从中医医院的特殊视角出发,围绕患者就医全流程,以基于提升患者体验构建中医药特色门诊服务为工作目标,推出了“十个一”方案,落实了10项具体举措。以此提升患者门诊体验,取得了丰硕成效,进一步加强了中医医院的中医药人文建设和文化内涵。

Megestrol acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and early-stage endometrial adenocarcinoma: a prospective study

Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.

Linggui Zhugan Decoction Improves High Glucose-Induced Autophagy in Podocytes

Objective To explore the influence of Linggui Zhugan Decoction(LGZGD) on high glucose induced podocyte autophagy.Methods LGZGD containing serum was prepared by intragastric administation of 4.2 g/kg(low dose), 8.4 g/kg(medium dose), and 12.6 g/kg(high dose) LGZGD into SD rats respectively. MPC5 and AB8/13 podocyte cells were treated with 60 mmol/L glucose to establish diabetic nephropathy podocyte model in vitro. Both podocytes were divided into control group, high glucose group, low dose LGZGD group, medium dose LGZGD group, and high dose LGZGD group, respectively. For the three LGZGD groups, before LGZGD intervention, podocytes were treated with 60 mmol/L glucose for 3 days. After treated with LGZGD containing serum, cells were collected to analyze cell migration using Transwell assay, proliferation using CCK8, apoptosis and cell cycle using flow cytometry, autophagosome formation using transmission electron microscopy, and expression levels of Beclin-1, Atg5, LC3II/I, and P62 proteins using Western blot.Results Compared with the control group, the proliferation and migration of MPC5 and AB8/13 cells in the high glucose group slightly decreased, whereas these parameters restored after intervention with low and medium concentrations of LGZGD, with the medium dose LGZGD having the better effect(P < 0.05). Flow cytometry showed that the medium dose LGZGD group had a significantly lower apoptosis rate(P < 0.05) and higher survival rate(P > 0.05) compared to the high dose LGZGD group. High glucose arrested podocytes in G1 phase, whereas LGZGD shifted podocytes from being predominant in G1 phase to G2 phase. High dose LGZGD significanly reduced high glucose-increased autophagosome formation in both podocytes(P < 0.05). Western blot analysis showed that Beclin-1, Atg5, LC3II/I, and P62 expressions were increased in MPC5 cells treated with high glucose and reversed after adminstration of low and medium doses of LGZGD(P < 0.05).Conclusion LGZGD reduced apoptosis and enhanced autophagy in high glucose treated podocytes via regulating Beclin-1/LC3II/I/Atg5 expression.

Downregulation of MUC1 Inhibits Proliferation and Promotes Apoptosis by Inactivating NF-κB Signaling Pathway in Human Nasopharyngeal Carcinoma

Objective To investigate the effect of mucin 1(MUC1)on the proliferation and apoptosis of nasopharyngeal carcinoma(NPC)and its regulatory mechanism.Methods The 60 NPC and paired para-cancer normal tissues were collected from October 2020 to July 2021 in Quanzhou First Hospital.The expression of MUC1 was measured by real-time quantitative PCR(qPCR)in the patients with PNC.The 5-8F and HNE1 cells were transfected with siRNA control(si-control)or siRNA targeting MUC1(si-MUC1).Cell proliferation was analyzed by cell counting kit-8 and colony formation assay,and apoptosis was analyzed by flow cytometry analysis in the 5-8F and HNE1 cells.The qPCR and ELISA were executed to analyze the levels of TNF-αand IL-6.Western blot was performed to measure the expression of MUC1,NFкB and apoptosis-related proteins(Bax and Bcl-2).Results The expression of MUC1 was up-regulated in the NPC tissues,and NPC patients with the high MUC1 expression were inclined to EBV infection,growth and metastasis of NPC.Loss of MUC1 restrained malignant features,including the proliferation and apoptosis,downregulated the expression of p-IкB、p-P65 and Bcl-2 and upregulated the expression of Bax in the NPC cells.Conclusion Downregulation of MUC1 restrained biological characteristics of malignancy,including cell proliferation and apoptosis,by inactivating NF-κB signaling pathway in NPC.

Role of microglial polarization in age-related macular degeneration

Microglia,originating from primitive macrophages in the yolk sac,serves as both immune system defenders and regulators of homeostasis.These cells exhibit two primary polarization states:conventionally activated(M1)and alternatively activated(M2).The polarization of microglia plays a crucial role in influencing inflammatory disorders,metabolic imbalances,and neural degeneration.This process is implicated in various aspects of ocular diseases,especially age-related macular degeneration(AMD),including inflammation,oxidative stress and pathological angiogenesis.The distinct functional phenotypes of microglia impact disease progression and prognosis.Thus,regulating the polarization or functional phenotype of microglia at different stages of AMD holds promise for personalized therapeutic approaches.This comprehensive review outlines the involvement of microglia polarization in both physiological and pathological conditions,emphasizing its relevance in AMD.The discussion underscores the potential of polarization as a foundation for personalized treatment strategies for AMD.

UBE2C as an Immune-Related Biomarker for Breast Cancer:A Study Based on Multiple Databases

Objective To screen the target genes that are associated with survival of breast cancer(BRCA) and explore their prognostic values and immune correlations with BRCA using multiple databases..Methods The microarray expression datasets of BRCA were downloaded from the Gene Expresssion Omnibus database(GEO) and analyzed to obtain differentially expressed genes(DEGs). Hub genes were obtained by constructing and visualizing the protein-protein interaction network of DEGs. The key gene was determined using R language, STRING, and Cytoscape, and the differential expression of the key gene was verified using external datasets The Cancer Genome Atlas(TCGA) and quantitative real-time PCR(q RT-PCR) for BRCA tissues of 37 patients. The prognostic value and immunological correlation of UBE2C in BRCA were explored using R language, TIMER, and Gene Set Enrichment Analysis(GSEA).Results Of 10 hub genes seleceed from 302 DEGS, UBE2C was identified as the gene associated with BRCA survival. The expression of UBE2C was differentially upregulated in BRCA, as verified by TCGA and q RT-PCR. Prognostic analysis revealed that UBE2C served as an independent prognostic factor. High expression of UBE2C was associated with decreased immune infiltration levels of B cells, CD4+ T cells, CD8+ T cells, macrophages, and myeloid dendritic cells in BRCA tissue. The expression of UBE2C in BRCA showed a significant correlation with immune checkpoints genes PDCD1, CD274, and CTLA4 expressions. There was a positive correlation between the expression of UBE2C and the tumor mutational burden and microsatellite instability. GSEA demonstrated that UBE2C expression significantly enriched 786 immune-related gene sets.Conclusions UBE2C expression in BRCA tissues is closely related to the BRCA immune microenvironment and showes predictive values on the survivals and prognosis of BRCA patients and the effecacy of immunotherapy. UBE2C may be an potential immune-related prognostic biomarker for BRCA.

Correlations of transcranial sonography of substantia nigra characteristics with MRI iron deposition on substantia nigra in patients with Parkinson disease

Objective To explore the correlations of transcranial sonography of substantia nigra(SN-TCS)characteristics with MRI iron deposition on substantia nigra in patients with Parkinson disease(PD).Methods Data of SN-TCS and craniocerebral MRI in 120 PD patients were retrospectively analyzed.The patients were divided into iron deposition positive group(positive group,n=46)and iron deposition negative group(negative group,n=74)according to quantitative susceptibility mapping(QSM)value.Then parameters of SN-TCS and MRI were compared between groups(both P<0.05),and correlation analysis were also performed.Results The proportion of high echo positive,strong echo area and QSM value of substantia nigra,as well as of hyper-substantia nigra area/midbrain area(S/M)in positive group were all higher than those in negative group(all P<0.001).No significant difference of midbrain area was found between groups(P>0.05).Strong echo area of substantia nigra and S/M based on SN-TCS were both low-medium positively correlated with substantia nigra QSM value showed on MRI(r=0.497,0.529,both P<0.001).Conclusion SN-TCS characteristics of PD patients were correlated with MRI iron deposition on substantia nigra,among which strong echo area and S/M were valuable for evaluating iron deposition on substantia nigra.

Differentiating consistency of meningioma based on grey-level histogram analysis of T2WI

Objective To observe the value of grey-level histogram analysis based on T2WI for differentiating consistency of meningioma.Methods Data of 109 patients with meningioma were retrospectively analyzed.The patients were divided into hard group(n=71)and soft group(n=38)according to the consistency of tumors.Tumor ROI was outlined on axial T2WI showing the largest tumor section,gray levels were extracted and histogram analysis was performed.The value of each histogram parameter were compared between groups.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficiency for differentiating soft and hard meningioma.Results P 1,P 10,P 50,P 90,P 99 and the mean grey levels on T2WI in soft group were all higher than those in hard group(all P<0.05),while the variance,the kurtosis and the skewness were not significantly different between groups(all P>0.05).The differentiating efficiency of P 1,P 10,P 50,P 90,P 99 and the mean grey levels on T2WI were all fine,with AUC of 0.774 to 0.833,and no significant difference was found(all P>0.05).Conclusion Parameters of grey-level histogram analysis such as P 1,P 10,P 50,P 90,P 99 and the mean values based on T2WI were all valuable for differentiating soft and hard meningioma.

Vascular Calcification:Where is the Cure?

With the progress of aging,the incidence of vascular calcification(VC)gradually increases,which is correlated with cardiovascular events and all-cause death,aggravating global clinical burden.Over the past several decades,accumulating approaches targeting the underlying pathogenesis of VC have provided some possibilities for the treatment of VC.Unfortunately,none of the current interventions have achieved clinical effectiveness on reversing or curing VC.The purpose of this review is to make a summary of novel perspectives on the interventions of VC and provide reference for clinical decision-making.

Right heart modified myocardial performance index and ductus venosus spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes

Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.

Dissecting Causal Relationships Between Plasma Metabolites and Osteoporosis:A Bidirectional Mendelian Randomization Study

Objective To investigate the causal relationships between plasma metabolites and osteoporosis via Mendelian randomization(MR) analysis.Methods Bidirectional MR was used to analyze pooled data from different genome-wide association studies(GWAS). The causal effect of plasma metabolites on osteoporosis was estimated using the inverse variance weighted method, intersections of statistically significant metabolites obtained from different sources of osteoporosis-related GWAS aggregated data was determined, and then sensitivity analysis was performed on these metabolites. Heterogeneity between single nucleotide polymorphisms was evaluated by Cochran's Q test. Horizontal pleiotropy was assessed through the application of the MR-Egger intercept method and the MRPRESSO method. The causal effect of osteoporosis on plasma metabolites was also evaluated using the inverse variance weighted method. Additionally, pathway analysis was conducted to identify potential metabolic pathways involved in the regulation of osteoporosis.Results Primary analysis and sensitivity analysis showed that 77 and 61 plasma metabolites had a causal relationship with osteoporosis from the GWAS data in the GCST90038656 and GCST90044600 datasets, respectively. Five common metabolites were identified via intersection. X-13684 levels and the glucose-to-maltose ratio were negatively associated with osteoporosis, whereas glycoursodeoxycholate levels and arachidoylcarnitine(C20) levels were positively associated with osteoporosis(all P < 0.05). The relationship between X-11299 levels and osteoporosis showed contradictory results(all P < 0.05). Pathway analysis indicated that glycine, serine, and threonine metabolism, valine, leucine, and isoleucine biosynthesis, galactose metabolism, arginine biosynthesis, and starch and sucrose metabolism pathways were participated in the development of osteoporosis.Conclusion We found a causal relationship between plasma metabolites and osteoporosis. These results offer novel perspectives with important implications for targeted metabolite-focused interventions in the management of osteoporosis.

Research progress on the correlation between aqueous humor components and pathogenesis and postoperative complications in patients with different types of cataracts

Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during the operation.This review intended to analyze the components of aqueous humor in patients with different types of cataracts'so as to reflect the pathogenesis and development of the disease'evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery.The aqueous humor components of different types of cataracts showed different degrees of inflammation'oxidative stress and extracellular matrix remodeling.The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1).Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome.The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows:Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha;capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2;Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery;capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases;pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery.Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk)'while MCP-1 mediated pain in the long interval(6 wk).The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors.The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease.Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.

Real-time shear wave elastography combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease

Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.

Role of bisphosphonates in osteoporosis caused by adult growth hormone deficiency

In recent years,growth hormone and insulin-like growth factors have become key regulators of bone metabolism and remodeling,crucial for maintaining healthy bone mass throughout life.Studies have shown that adult growth hormone deficiency leads to alterations in bone remodeling,significantly affecting bone microarchitecture and increasing fracture risk.Although recombinant human growth hormone replacement therapy can mitigate these adverse effects,improving bone density,and reduce fracture risk,its effectiveness in treating osteoporosis,especially in adults with established growth hormone deficiency,seems limited.Bisphosphonates inhibit bone resorption by targeting farnesyl pyrophosphate synthase in osteoclasts,and clinical trials have confirmed their efficacy in improving osteoporosis.Therefore,for adult growth hormone deficiency patients with osteoporosis,the use of bisphosphonates alongside growth hormone replacement therapy is recommended.

Multicenter Clinical Randomized Controlled Trial and Network Pharmacology Analysis of Zhenzhu Qingyuan Granules for the Treatment of Gastroesophageal Reflux Disease

Objective To evaluate the clinical efficacy and safety of Zhenzhu Qingyuan Granules through a clinical randomized controlled trial and to analyze the potential action targets and pathways of this formula using network pharmacology.Methods Patients with gastroesophageal reflux disease(GERD)of liver–stomach stagnant heat pattern who met the inclusion and exclusion criteria were randomly divided into the control group and the observation group.The control group received oral rabeprazole,whereas the observation group were given Zhenzhu Qingyuan Granules in addition to the rabeprazole.The treatment duration was 8 weeks.Clinical efficacy was observed in both groups after 8 weeks.Network pharmacology was used to analyze the action targets of ZhenzhuQingyuanGranules and the genes related to GERD,and core targets were inferred.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted to explore the potential mechanisms of this formula.Results The clinical research results showed that the total effective rate in the treatment group was 92.68%,compared with 70.00%in the control group,with a statistically significant difference(p<0.05).After treatment,both Chinese medicine syndrome score and endoscopic score improved in both groups compared with before treatment(p<0.05),and the treatment group showed greater improvement than the control group(p<0.05).Network pharmacology identified effective components of Zhenzhu Qingyuan Granules for treating GERD,including quercetin,luteolin,andβ-sitosterol,with potential action targets such as tumor protein 53(TP53),protein kinase B(AKT1),and tumor necrosis factor.Conclusion Zhenzhu Qingyuan Granules can significantly improve clinical symptoms in patients with GERD of liver–stomach stagnated heat pattern,enhance clinical efficacy,and have high safety.This formula may exert therapeutic effects through multiple targets and pathways.

E-Cervix imaging displaying cervical elasticity characteristics of healthy adult nulliparous women at different age groups and different menstrual cycle stages

Objective To observe the cervical elasticity of healthy adult nulliparous women at different age groups and different stages of menstrual cycle with E-Cervix imaging technology.Methods A total of 218 healthy adult nulliparous women who underwent transvaginal ultrasound examination for routine physical examination were retrospectively enrolled,including 103 in follicular phase,78 in ovulation phase and 37 in luteal phase.Cervical canal length(CL)and E-Cervix elasticity parameters were compared among different age groups and different stages of menstrual cycle,including elasticity contrast index(ECI),hardness ratio(HR),cervical internal and external orifice strain values(IOS and EOS)and IOS/EOS ratio.Results No significant difference of CL nor cervical elasticity parameters was detected among healthy adult nulliparous women at different age groups(all P>0.05).There were significant differences of ECI,HR and IOS among different menstrual cycle stages(all P<0.05),among which women in follicular phase had higher ECI and IOS but lower HR than those in luteal phase(all P<0.05).Conclusion No significant difference of cervical elasticity existed among healthy adult nulliparous women at different age groups.Meanwhile,cervical elasticity of healthy adult nulliparous women changed during menstrual cycle,in follicular phase had higher ECI and IOS but lower HR than in luteal phase.

A Cognitive Study on Politeness Intention Processing and Its Association with Pragmatic Failure in Cross-Cultural Communication

Although a large number of studies have focused on various aspects of politeness,very little is known about how politeness intention is activated cognitively during verbal communication.The present study aims to explore the cognitive mechanism of politeness intention processing,and how it is related to pragmatic failure during cross-cultural communication.Using 30 Chinese EFL university students who were instructed to finish a probe word judgment task with 96 virtual scenarios,the results indicate that within both mono-and cross-cultural contexts,the response time in the experimental scenarios was significantly slower than that of the filler scenarios.This suggests that politeness intention was activated while understanding the surface meaning of the conversation;however,the EFL learners could not completely avoid the negative transfer of their native politeness conventions when they were comprehending the conversational intention of the target language.Furthermore,no significant differences in response time were found between the groups with high and low English pragmatic competence,illustrating that transferring the pragmatic rules and principles into cross-cultural communication skills was more cognitively demanding.Overall,this study adds to the literature on politeness research and provides some implications for foreign language pragmatic instructions.

Research progresses of artificial intelligence in MRI of lumbar degenerative diseases

The incidence of lumbar degenerative diseases is increasing year by year,and MRI is often used in clinical diagnosis.In recent years,artificial intelligence(AI)has rapidly developed in medical field and can be used for image segmentation and auxiliary diagnosis of lumbar degenerative diseases.The research progresses of AI in MRI of lumbar degenerative diseases were reviewed in this article.

Mechanical Properties and Thermal Shock Resistance of SrAl_(2)Si_(2)O_(8) Reinforced BN Ceramic Composites

Hexagonal boron nitride(h-BN)ceramics have become exceptional materials for heat-resistant components in hypersonic vehicles,owing to their superior thermal stability and excellent dielectric properties.However,their densification during sintering still poses challenges for researchers,and their mechanical properties are rather unsatisfactory.In this study,SrAl_(2)Si_(2)O_(8)(SAS),with low melting point and high strength,was introduced into the h-BN ceramics to facilitate the sintering and reinforce the strength and toughness.Then,BN-SAS ceramic composites were fabricated via hot press sintering using h-BN,SrCO_(3),Al_(2)O_(3),and SiO_(2) as raw materials,and effects of sintering pressure on their microstructure,mechanical property,and thermal property were investigated.The thermal shock resistance of BN-SAS ceramic composites was evaluated.Results show that phases of as-preparedBN-SAS ceramic composites are h-BN and h-SrAl_(2)Si_(2)O_(8).With the increase of sintering pressure,the composites’densities increase,and the mechanical properties shew a rising trend followed by a slight decline.At a sintering pressure of 20 MPa,their bending strength and fracture toughness are(138±4)MPa and(1.84±0.05)MPa·m^(1/2),respectively.Composites sintered at 10 MPa exhibit a low coefficient of thermal expansion,with an average of 2.96×10^(-6) K^(-1) in the temperature range from 200 to 1200℃.The BN-SAS ceramic composites prepared at 20 MPa display higher thermal conductivity from 12.42 to 28.42 W·m^(-1)·K^(-1) within the temperature range from room temperature to 1000℃.Notably,BN-SAS composites exhibit remarkable thermal shock resistance,with residual bending strength peaking and subsequently declining sharply under a thermal shock temperature difference ranging from 600 to 1400℃.The maximum residual bending strength is recorded at a temperature difference of 800℃,with a residual strength retention rate of 101%.As the thermal shock temperature difference increase,the degree of oxidation on the ceramic surface and cracks due to thermal stress are also increased gradually.