With the diversification in surgical population and the progress of surgical techniques, the current clinical application of pre-operative pulmonary function assessment methods can hardly be qualified for accurately assessing whether lung cancer patients can tolerate surgical treatment and surgery-related risk. This paper focuses on the advantages and weaknesses of the commonly-used pul-monary function assessment methods, with the literature review of the clinical application status and progress of pulmonary function currently. We aim to achieve a reasonable evaluation of preoperative cardio-pulmonary function assessment, and sequentially reduce the risk and occurrence of surgical-related complications.

Objective To explore the effect of folic acid on neural stem cells(NSCs) proliferation from fetal rats in vitro.Method NSCs were isolated and cultured by microdissection,mechanical blowing and serum-free suspension culture,and identified by immunofluorescent staining using antibody against nestin.BrdU(5’bromo-2’deoxyuridine) was used to mark dividing neural stem cells.Cultured NSCs were divided into four groups:control group,low,high dose group(liquid media with added 4,40 mg/L folic acid),and deficiency group(liquid media with added 0.4 mg/L methotrexate,MTX).Monotetrazolium(MTT) and double-label immunofluorescence technique detected NSCs proliferation under the condition of folic acid.Results In the serum-free suspension medium,neurospheres that consisted of a great number of nestin-positive cells could be obtained.The proliferative ability of NSCs were observed by BrdU labeling methods.MTT assay and double-label immunofluorescence for nestin+BrdU showed that the growth tendency was increased with folate concentration in the medium.Compared with control group,NSCs growth rate of folate group was significantly increased in vitro.Conclusion The culture of NSCs isolated from fetal rats possesses the abilities of proliferation and self-regeneration.Folic acid may stimulate proliferation of NSCs efficiently.

Objective:To investigate the therapeutic range of tacrolimus and effects of tacrolimus on liver and re- nal functions and blood routine in renal transplant recipients.Method:The whole blood tacrolimus concentration was meas- ured by micro-particle enzyme immunoassay(MEIA).Blood tacrolimus concentrations in 390 cases of renal transplant re- cipients were analyzed.The effects of tacrolimus on liver and renal function and blood routine were also studied.Result: The blood tacrolimus concentrations in 377 of 390 cases were within the range from 3 to 15?g?L~(-1).Their blood tacrolimus concentration differed greatly in renal transplant recipients within 6 months after transplantation.Their blood tacrolimus concentration was gradually decreased as time went on.Tacrolimus with therapeutic dosage had no effects on liver and renal function and blood routine.Conclusion:The therapeutic ranges of tacrolimus with MEIA were as follows:5 to 15?g?L~(-1) within 3 months after transplantation,5 to 10?g?L~(-1)between 4 to 6 months after transplantation,3 to 10?g?L~(-1)6 months after transplantation.The administration of tacrolimus had no effects on the liver and renal function and blood routine in re- nal transplant recipients.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Objective To investigate the application value of ultrasound-guided fine-needle aspiration cytology of lymph nodes in the pre-radiotherapy evaluation of superficial lymph nodes metastases in patients with lung cancer and esophageal cancer. Methods A total of 115 patients with lung cancer and esophageal cancer prepared for thoracic radiotherapy from February 2017 to September 2018 in Cancer Hospital of Huanxing Chaoyang District Beijing were retrospectively analyzed. Ultrasound-guided fine-needle aspiration cytology examination was performed in 166 lymph nodes. Puncture tissues were prepared for cytology production. Then cytological specialist read the film to evaluate if the cancer cells metastasis were present after conventional papanicolaou staining. The effects of short diameter of lymph nodes, blood flow signal and tumor characteristics of patients on the results of cytological examination were analyzed. Results The ultrasound results showed the median short diameter of lymph nodes was 0.6 cm (0.2-3.5 cm), and 25 (15.1％) lymph nodes had blood flow signals, 50 (30.1％) lymph nodes had positive results of puncture tissues cytology. The positive rate of puncture tissues cytology was 10.0％(4/40), 21.6％(21/97) and 86.2％(25/29) in the shortdiameter of lymph nodes <0.5 cm group, ≥0.5 cm and <1 cm group, and ≥1 cm group, respectively (P<0.01). Cytology positive rate of lymph nodes with or without blood flow signal detected by ultrasound was 48.0％ (12/25) and 27.0％ (38/141), and there was a statistical difference (P = 0.034). Location of primary tumor, T stage and chemotherapy history had no significant influence on the cytological results in patients with lung cancer (all P> 0.05). Pathological types had a significant influence on cytological results (χ2= 8.050, P= 0.045). Lymph node metastasis of the upper mediastinum was a risk factor for lymph node metastasis in lower neck and supraclavicular region (χ2= 9.699, P= 0.002). Location of primary tumor, T stage and chemotherapy history had no significant influence on cytological results in patients with esophageal cancer (all P> 0.05). Conclusions Ultrasound-guided fine-needle aspiration cytology is safe and efficient. It can be used to evaluate the metastasis status of superficial lymph nodes in pre-radiotherapy patients with lung cancer and esophageal cancer.

Objective To explore the effect of jejunum tube implantation on the reduction of adverse reactions,outcomes improvement and cost reduction in esophageal cancer patients with radiotherapy. Methods Eighty-two esophageal cancer patients with nutritional risk in Beijing Chaoyang District Huanxing Cancer Hospital from August 2014 to December 2016 were analyzed. Forty-one cases received jejunum tube implantation (implantation group) and 41 cases received non-nutrient tube implantation (control group), and data on their nutritional status,clinical efficacy,adverse reactions,and hospitalization costs were collected and compared. Results Compared with the control group, the implantation group has higher body mass index [(21.7±0.5)kg/m2vs. (19.5±0.3) kg/m2,t =2.12,P =0.031], hemoglobin[(120.0±2.1) g/L vs. (115.0±6.3) g/L, t= 2.12, P= 0.031] and clinical efficacy [95.1 % (39/41) vs. 87.8 % (36/41), χ2= 6.11, P= 0.022]. The incidence of adverse reactions in implantation group was significantly lower than that in control group[29.3 % (12/41) vs. 51.2 %(21/41),χ 2=8.12,P=0.002). The total cost in implantation group was lower than that in control group (138 000 yuan vs. 147 000 yuan, t= 2.09, P= 0.037), and the average hospitalization day was significantly reduced (42.1 d vs. 48.4 d, t = 2.27, P = 0.029). Conclusion Enteral nutrition support with jejunal feeding tube can reduce the incidence of adverse reactions, improve the curative effect, shorten hospitalization time and save medical cost for patients with esophageal cancer.

Objective To compare the effect of nutritional support with and without tube feeding on the incidence of adverse reactions in radiotherapy for esophageal cancer.Methods A total of 120 esophageal cancer patients with high-risk factors receiving radiotherapy were selected and randomly assigned into the tube feeding (TF,n=60) and non-tube feeding groups (NTF,n=60) according to the random number method.Nutritional interventions were performed during radiotherapy in both groups.The incidence of esophagitis and myelosuppressioa,aulmonary infectioa,autritional status and the completion of radiotherapy were observed and statistically compared between TF and NTF groups.Results In the TF groua,ahe incidence of ≥ grade 2 esophagitis was lower than that in the NTF group.The incidence of grade 3 esophagitis significantly differed between two groups (P＜ 0.05).The incidence of grade 1-2 myelosuppression did not differ between two groupa,ahereas the incidence of grade 3 myelosuppression in the TF group was significantly lower than that in the NTF group (P＜0.05).In the TF groua,ahe incidence of pulmonary infection was remarkably lower than that in the NTF group (P＜0.05).The changes of BMI and prealbumin in the TF group were better than those in the NTF group (both P＜0.05).One patient in the NTF group failed to complete the radiotherapy due to grade Ⅳ esophagitia,and 5 cases in the NTF group (P＜ 0.05).In the TF groua,ahe length of hospital stay was significantly shortened by 6.2 d on average (P＜ 0.05).Conclusions During radiotherapy for esophageal cancer patients with high-risk factora,autritional support with tube feeding can effectively reduce the incidence of adverse reactiona,amprove the completion rate of treatmena,and shorten the average length of hospital stay.

BACKGROUND:Rapid developments in the field of bioinformatics have provided new methods for the diagnosis of osteoarthritis.Artificial neural networks have powerful data computing and classification capabilities,which have shown better performance in disease diagnosis. OBJECTIVE:To establish a new diagnostic predictive model of osteoarthritis based on artificial neural network and to verify the diagnostic value of the model in osteoarthritis with an external dataset. METHODS:The eligible osteoarthritis-related data sets were downloaded through GEO database search and divided into Train group and Test group.The gene expression matrix of the Train group was analyzed to screen the differentially expressed genes.GO and KEGG enrichment analyses were performed on the differentially expressed genes.Through Lasso regression model,support vector machine model and random forest tree model,the key genes of osteoarthritis were further identified from the differentially expressed genes.The R software"Neuralnet"package was then used to construct the osteoarthritis diagnosis model based on artificial neural network,and the model performance was evaluated by the five-fold cross-validation.Two independent data sets in the Test group were used to verify their diagnostic results. RESULTS AND CONCLUSION:A total of 90 differentially expressed genes related to osteoarthritis were obtained by differential analysis,of which 33 were down-regulated and 57 were up-regulated.GO enrichment analysis showed that the differentially expressed genes were mainly involved in the following biological processes,including leukocyte-mediated immunity,leukocyte migration in bone marrow and chemokine production.KEGG enrichment analysis showed that these genes were mainly enriched in rheumatoid arthritis,interleukin-17 signaling pathway and osteoclast differentiation pathway.Five key genes for the diagnosis of osteoarthritis,HMGB2,GADD45A,SLC19A2,TPPP3 and FOLR2,were identified by three machine learning methods.The artificial neural network model of five key genes in the Train group showed that the accuracy was 96.36%and the area under the curve was 0.997.The five-fold cross validation of the neural network model showed that the average area under the curve was greater than 0.9 and the model was of robustness.Two independent data sets in the Test group showed its area under the curve was 0.814 and 0.788 respectively.Therefore,the establishment of an artificial neural network model for the diagnosis of osteoarthritis has a certain diagnostic value.

【Objective】 To analyze the related factors and countermeasures of adverse reactions to whole blood donation(ARBD) for medical student donors, so as to further reduce the incidence of ARBD. 【Methods】 The demographic data of medical/non-medical student donors and those suffered from ARBD from 2016 to 2018 were retrospectively analyzed, and the relationship between ARBD and age, gender, frequency of blood donation, blood volume, blood type, pulse, ALT, blood pressure, hemoglobin, etc. was statistically analyzed. 【Results】 The incidence of ARBD in all medical student donors from 2016 to 2018 was 1.16%, lower than that of non-medical students (1.51%). The ARBD rate(2.30%) of senior medical students (> 20 years old) was significantly lower than that of non-medical students (3.93%) and higher than that of junior medical students (≤20 years old)(0.70%). The ARBD rate of novel medical student donors was 1.27%, lower than that of novel non-medical students (2.12%) (P<0.05). Male medical students(1.68%) were more likely to develop ARBD than females(0.78%), donations within 200 mL(55%) than 300mL(0.26%) and 400mL(0), Hb<120 g/L(13.04%) than Hb≥120 g / L( 1.10% ), and blood type A(1.70%) than type O (0.88%) (P<0.05). Logistic regression analysis showed that blood volume and blood type were related factors. ARBD was more likely to occur in Type A blood than type O, and was more likely to occur when blood volume was lower. ARBD occurred frequently during phlebotomy, due to mental stress(75%) and hunger(8.92%)(P<0.05), while 96.43% of ARBD could recover within 10 minutes. 【Conclusion】 Novel, male, older than 20 years, Hb<120 g / L, blood type A and donation unit ≤200 mL were main risks for ARBD in medical student donors. Popularizing the knowledge of voluntary blood donation and strengthening pre-donation communication are important measures to prevent ARBD.