The development and change patterns as well as the disease course management of multiple ground-glass nodules(GGNs)in the lungs are currently hotspots and difficulties in clinical lung cancer research.Understanding the latest advancements in the natural history of multiple GGNs is crucial for grasping the disease variation patterns and formulat-ing management strategies.Meanwhile,utilizing advanced methods such as intelligent follow-up management platforms makes the long-term standardized management of GGNs possible.Therefore,this article provides an overview of the latest research advancements on the natural history of multiple GGNs and new experience in GGNs management.

Objective:To study the main blood parameters of Leishmania-infected dogs with different clinical symptoms in the high incidence area of visceral leishmaniasis in Gansu Province, and to provide scientific basis for early diagnosis and monitoring of canine leishmaniasis. Methods:In May 2019, Wenxian County of Longnan City and Diebu County of Gannan Tibetan Autonomous Prefecture, the historical endemic areas of visceral leishmaniasis in Gansu Province, were selected as the investigation sites, and 40 dogs with positive Leishmania DNA were investigated. According to their clinical symptoms, they were divided into three groups: asymptomatic ( n = 17), minimally symptomatic ( n = 12) and symptomatic ( n = 11). At the same time, 10 healthy dogs were selected as controls. Major blood indexes were detected by an automatic animal blood five-classification cell analyzer. Results:Compared with the control group, the number of red blood cells, hemoglobin content, hematocrit, and the number of lymphocytes, monocytes and eosinophils in the asymptomatic, minimally symptomatic and symptomatic groups were decreased ( P < 0.05), while the number of white blood cells and neutrophils in minimally symptomatic and symptomatic groups were decreased ( P < 0.05). The above blood indexes were lower in the symptomatic group than those in the asymptomatic group. The number of red blood cells (control group vs symptomatic group) decreased from (6.82 ± 0.05) × 10 12/L to (4.19 ± 0.08) × 10 12/L, hemoglobin content decreased from (15.84 ± 0.74) g/L to (9.65 ± 0.18) g/L, hematocrit decreased from (46.41 ± 0.95)% to (27.86 ± 0.42)%, the number of white blood cells decreased from (14.90 ± 0.22) × 10 9/L to (10.23 ± 0.24) × 10 9/L, the number of neutrophils decreased from (7.25 ± 0.18) × 10 9/L to (6.18 ± 0.11) × 10 9/L, the number of lymphocytes decreased from (2.80 ± 0.07) × 10 9/L to (1.64 ± 0.06) × 10 9/L, the number of monocytes decreased from (1.13 ± 0.01) × 10 9/L to (0.53 ± 0.02) × 10 9/L, and the number of eosinophils decreased from (1.70 ± 0.06) × 10 9/L to (0.71 ± 0.03) × 10 9/L. Conclusion:Different clinical symptoms of Leishmania-infected dogs have different blood test results.

ObjectiveTo identify the members of the Rehmannia glutinosa miR166 gene family and clarify the response mode under adversity. MethodHigh-throughput sequencing technology was employed to obtain a small RNA database and the miR166 family members of R. glutinosa were screened out. The precursor structures were analyzed by RNAfold. DNAMAN and MEGA were used for conservative and evolutionary analyses， respectively. TargetFinder software was used to predict the target genes of R. glutinosa miR166 family members. The expression of miR166 family members in response to abiotic stress was analyzed by real-time polymerase chain reaction（Real-time PCR）. ResultFive miR166s were identified with precursors possessing complete stem-loop structures. As revealed by sequence alignment results， the precursors and matures were both highly conserved. Forty-eight target genes of miR166s were predicted， which were mainly annotated to the HD-ZIP Ⅲ family transcription factors. The expression characteristics showed that the expression of miR160s was up-regulated after R. glutinosa was infected by endophytic fungi， which was different from the expression of the family members under abiotic stress. The expression level of rgl-miR166b-5p in the drought-flood treatment group and the high-low temperature treatment group was significantly down-regulated compared with that in the control group， and the expression pattern was opposite under the endophytic fungal infection. ConclusionThe results of this study preliminarily clarified the expression patterns of R. glutinosa in response to biotic and abiotic stresses and provided a theoretical basis for future breeding and improvement of R. glutinosa.

Objective:To learn about the diagnosis of Kala-azar in Gansu Province, and to provide a basis for formulating corresponding prevention and control measures.Methods:The data (age, gender, onset time, diagnosis time, diagnosis unit, etc.) of Kala-azar cases in Gansu Province from January to December 2018 were collected from the China Disease Prevention and Control Information System. At the same time, a case report questionnaire was designed to collect information such as the initial diagnosis unit and initial diagnosis results; a diagnosis and treatment questionnaire of medical institutions was designed to investigate the knowledge of diagnosis and treatment of Kala-azar (main epidemic areas, main symptoms, common detection methods, main therapeutic drugs and drug use methods) among doctors in county and township hospitals, and the pass rate and awareness rate were calculated.Results:A total of 47 Kala-azar cases were included, with an average age of 17 years. Among them, men accounted for 57.45% (27/47) and women accounted for 42.55% (20/47). Among the initial diagnosis hospitals, the proportions of provincial, municipal, county and township hospitals were 2.13% (1/47), 12.77% (6/47), 42.55% (20/47) and 42.55% (20/47), respectively; among the hospitals with confirmed cases, provincial, municipal, county and township hospitals accounted for 48.94% (23/47), 31.91% (15/47), 19.15% (9/47) and 0 (0/47), respectively. The shortest time from initial diagnosis to diagnosis of the 47 cases was 1 day; the longest was 124 days, with an average of 27 days. A total of 96 valid questionnaires were collected from doctors in county and township hospitals, of which 30 scored 60 points or above, and the pass rate was 31.25% (30/96). Among the five surveys on diagnosis and treatment knowledge of Kala-azar, doctors in county and township hospitals had the highest awareness rate of "main therapeutic drugs", which was 77.08% (74/96), and there was significant difference (χ 2 = 9.86, P = 0.002) between doctors in the two-level hospitals [90.00% (45/50), 63.04% (29/46)]. The awareness rate of "main symptoms" was the lowest, which was 25.00% (24/96), and there was significant difference (χ 2 = 4.51, P = 0.034) between doctors in the two-level hospitals [34.00% (17/50), 15.22% (7/46)]. Conclusions:The awareness rate of diagnosis and treatment knowledge of Kala-azar among doctors in county and township hospitals in Gansu Province is low, and their diagnostic ability is weak. It is recommended to strengthen the training of clinicians, improve the timeliness of diagnosis, and achieve early diagnosis, early report and early treatment of Kala-azar.

Objective To explore dendritic cells (DCs)-mediated antigen presentation for radiation-injured cells by using the in vitro cell co-culture technology to simulate the in vivo microenvironment of the lung tissue. Methods ⁶⁰Co γ-irradiated mouse lung epithelial cells (MLE-12) were cultured with bone marrow-derived DCs and/or splenic T lymphocytes for 48 hours. Flow cytometry was used to measure the expression levels of costimulatory molecules (CD80/86) and antigenic peptide recognition complexes (the major histocompatibility complex [MHC] class Ⅰ/Ⅱ) on DCs and T cell activation markers (CD69/28/152) as well as the numbers of CD4⁺ and CD8⁺ T cells. Results ⁶⁰Co γ irradiation significantly increased the apoptosis rate of MLE-12 cells in a dose-dependent manner, and significantly stimulated the expression of CD80/86 and MHC Ⅱ on DCs, without direct activation of T cells. After γ (6 Gy)-irradiated MLE-12 cells were co-cultured with DCs and T lymphocytes for 48 h, there were significant increases in the expression of CD69 and CD28 on T cells, the numbers of CD4⁺ and CD8⁺ T cells, and the expression of CD86 and MHC I on DCs, as compared with the control groups. Conclusion Radiation-injured cells can stimulate antigen presentation by DCs and activate T cells.

Objective To investigate the role of complement in radiation-induced lung injury in mice after chest irradiation with ⁶⁰Co γ-rays at a single dose of 20 Gy. Methods C57BL/6 mice underwent chest irradiation with ⁶⁰Co γ-rays at a single dose of 20 Gy, followed by observation for the inflammatory reaction of the lung tissue in the early stage (within 15 d) and pulmonary fibrosis in the later stage (30 and 180 d). Enzyme-linked immunosorbent assay was used to measure the levels of C2, C3a, C4, and C5b-9 in the lung tissues at 1, 3, 7, 15, 30, and 180 d after irradiation. The expression of complement mRNA in BEAS-2B cells after irradiation was determined using RT-PCR. Results Radiation-induced lung injury in micepresented as inflammatory response in the early stage and fibrosis in the late stage. Complement C2, C4, and C5b-9 complexes were increased in the early period (3 or 7 d) after irradiation (P < 0.05), which might be associated with the inflammatory response induced by irradiation. During 3 to 180 d, complement C3a was significantly higher in the irradiated mice than in the control mice, suggesting a close relationship between C3a and radiation-induced lung injury. The irradiated cells showed increased mRNA expression of C2 and C3, with no changes in the mRNA levels of C4 and C5. Conclusion Different complement proteins have varying responses to radiation-induced lung injury, among which C3a is closely related to radiation-induced lung injury, suggesting that regulating C3a and its receptors may be a new way to prevent and treat radiation-induced lung injury.

Hospital safety culture plays an important role in ensuring hospital service quality and safety. Based on the working practice of Changshu No.1 People′s Hospital and through the analysis of the current situation of hospital safety, the authors explored the construction of hospital safety culture from the aspects of organizational culture, system culture, atmosphere culture and improvement culture. It also discussed that in the process of safety culture construction, we should pay attention to stimulating employees′ innovation, enhancing effective communication, paying attention to the details of medical services, strengthening the implementation and effect test of the system, paying attention to humanistic care, and expanding the safety culture management mechanism to the grass-roots level.

Objective:To study on the effects of gastrointestinal function and portal vein hemodynamics applicated with abdominal hot compressing with evodiae fructus and crude salt after hepatectomy.Methods:A total of 60 patients who underwent hepatectomy were randomly divided into 2 groups by random number table method, with 30 in each group. The control group was treated with conventional basic western medicine, while the treatment group was treated with medicinal evodiae fructus and crude salt hot compress on abdomen on the basis of the control group. The portal vein diameter (PVD), portal venous flow velocity (PVV), recovery time of main clinical indexes, clinical symptom scores and liver function indexes were dynamically monitored at different observation time points.Results:The scores of abdominal distension, nausea and vomiting in the treatment group were significantly lower than those in the control group 3 days after treatment ( t values were -3.489 and -2.740, respectively, all Ps<0.05). The recovery time of bowel sounds, first exhaust time and first defecation time in the treatment group were significantly earlier than those in the control group ( t values were -3.622, -4.297 and -4.151, respectively, all Ps<0.01). With the extension of treatment time, ALT in 2 groups showed a gradual downward trend ( P<0.05 or P<0.01), DBIL in control group was significantly higher at 3 days after treatment than before ( t=-2.157, P=0.039), and TBIL was significantly lower at 7 days after treatment than before ( t=2.175, P=0.038). The PVD ( t values were 3.528, 2.160) and PVV ( t values were 11.096, 4.264) of the treatment group were significantly higher than those of the control group 3 and 5 days after treatment ( P<0.01 or P<0.05). Conclusion:Early application of abdominal hot compressing with evodiae fructus and crude salt hot compress on abdomen after hepatectomy can improve the portal vein blood circulation and promote the rehabilitation of gastrointestinal function in patients with hepatectomy.

Objective:To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods:Data of 20 patients (22 sided) with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed. There were 11 males and 9 females with an average of 42.1±3.2 years (range, 24-68 years). There were 7 cases of unilateral acetabular anterior column fracture, 2 cases of bilateral acetabular anterior column fracture (4 sides), 7 cases of anterior column with ipsilateral sacral fracture, and 4 cases of anterior column with sacroiliac joint injury. There were 3 hips of Area I, 6 Area II, 13 Area III of acetabular anterior column fractures according to Nakatani partition. The time from injury to surgery was 5 days (range, 3-11 days). All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy, and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction. The time of operation, the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded. Matta scoring criteria were used to assess fracture reduction quality, and hip function was assessed at the last follow-up according to the modified Merle D' Aubigné and Postel scoring system.Results:The average operative time was 22±10 min (range, 20-40 min) with an average times of intraoperative fluoroscopy of 30±8 times (range, 21-45 times), and the amount of intraoperative blood loss was 20±5 ml (range, 10-40 ml). 20 patients were followed up after operation for a period of 14±3.1 months (range, 12-18 months). The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria: anatomical reduction in 18 hips, satisfactory reduction in 2 hips, unsatisfactory reduction in 2 hips, with an excellent and good rate of 91% (20/22). The fracture healing time was 13±2.2 weeks (range, 11-16 weeks). At the lastest follow-up, hip function was assessed according to the modified Merle D' Aubigné and Postel scoring system: excellent 18, good 3, fair 1, and the satisfactory rate was 95%(21/22). No major neurological, vascular injury, wound infection and ectopic ossification were found during follow-up.Conclusion:Using laser-assisted axial fluoroscopy percutaneous screw to treat acetabular anterior column fracture, the operation is simple. And there is low risk to damage important blood vessels and nerves. This method can shorten the operation time of acetabular anterior column fracture, reduce the amount of blood loss during the operation, and the outcome is satisfactory.

Objective To explore the clinical efficacy of minimally invasive posterior reconstructive plating by parallel Kirschner wires in the treatment of unstable posterior pelvic fractures.Methods From January 2013 to December 2016,29 patients with unstable posterior pelvic fracture were treated at Trauma Center,Liuzhou Workers' Hospital.They were 22 men and 7 women,aged from 19 to 65 years (mean,44.2 years).By the Tile classification,10 cases were classified as type B and 19 as type C.The delay from injury to surgery ranged from 4 to 14 days (mean,8.7 days).All the patients received minimally invasive posterior fixation with a U-shaped reconstructive plate and parallel Kirschner wires.The length of incision,intraoperative bleeding,operation time,quality of fracture reduction,curative effects and complications at the last follow-up were recorded.Results The length of intraoperative unilateral incision ranged from 2.3 to 3.4 cm (average,2.99 cm);the volume of intraoperative bleeding ranged from 47 to 88 mL (average,69.9 mL);the average operation time ranged from 17 to 34 min (average,25.2 min).One patient was lost to the follow-up.The other 28 patients were followed up for 14 to 26 months (average,18.3 months).The fracture healing time ranged from 8 to 15 months (average,10.1 months).According to the Matta criteria for fracture reduction,17 cases were rated as excellent at the last follow-up,9 as good,one as fair and one as poor,giving an excellent to good rate of 92.9％.According to the Pohlemann functional scoring,14 cases were rated as excellent,11 as good,2 as fair and one as poor,giving an excellent to good rate of 89.3％.Conclusion In the treatment of unstable posterior pelvic fractures,minimally invasive posterior reconstructive plating by parallel Kirschner wires presents advantages of high security,limited surgical trauma,good curative effects and limited postoperative complications.