Objective To describe varied features of pulmonary metastases of lung cancer on CT imaging .Methods 194 patients with pulmonary metastases of lung cancer were evaluated on CT scan , including 106 men and 88 women . The median age of the patients was 45 years ( range from 22 to 78 years ) . The histology of the lung cancer included 56 squamous carcinomas(28.9%),107 adenocarcinomas(55.2%),26 small cell carcinomas(13.4%),and 5 adenosquamous carcinomas(2.1%).Results The usual pattern of pulmonary metastases of lung cancer were parenchyma nodules. The unusual form of metastases that were mainly found in adenocarcinomas were cavitary lesions, ground-glass nodules and lesions with unusual signals including lobulated structure, spiculated margin,pleural indentation and air-bronchogram. The manifestations of lymphangial spread to intrapulmonary were extensive uneven thickening of the interlobular septa and fissures, nodular thickening of brochovascular bundles and many fine nodulars distributed along the brochovascular bundles and interlobular septa.Conclusion The manifestations of intrapulmonary metastases of lung cancer are varied morphologic features.

Objective To analyze the effect of PDCA cycle quality management model on multi-drug resistant organism (MDROs) infec-tion control in a tertiary rehabilitation hospital. Methods From March, 2013 to December, 2015, targeted surveillance of MDROs infection control was performed with PDCA cycle quality control. The MDROs detection rate, the awareness rate of MDROs prevention and control, the rate of doctor issuing isolation orders and execution rate of medical sanitation disinfection and isolation were analyzed. Results The de-tection rates of methicillin-resistant staphylococcus aureus and Carbapenem-resistant Pseudomonas aeruginosa decreased (χ2>3.922, P<0.05), while no significant difference was found in the detection rate of multidrug-resistance Acinetobacter baumanii (χ2=8.775, P=0.071). The awareness rate of MDROs prevention and control, the rate of doctor issuing isolation orders and execution rate of medical sanitation dis-infection and isolation significantly improved (χ2>399.17, P<0.001). Conclusion PDCA cycle quality management model played an impor-tant role in the prevention and control of MDROs in rehabilitation hospital.

Objective To explore the reason of serious interference red blood cell(RBC)parameters in blood routine test and correct method.Methods 30 cases of patients whose results of blood routine RBC parameters obviously abnormal ,According to the interference factors were divided into four groups:cold agglutination (7 cases),severe hemolysis(13 cases),high triglycerides (8 cases),high white blood cell(WBC)(2 例).Take appropriate corrective action for processing respectively.The difference of red blood cell parameters were compared with t test.Results To analysis of interference factors and take appropriate corrective meas-ures,RBC parameters could be more close to the real results.Conclusion We should pay attention to the changes of the RBC pa-rameters,analysis of interference factors,and to take appropriate measures to correct,in order to avoid clinical misdiagnosis and mi-stherapy.

Objective The purpose of this study was to evaluate the constrast-enhanced CT features and pathologic findings of mediastinal tuberculous lymphadenitis in adults. Methods 39 patients with 180 lymph nodes diagnosed as mediastinal tuberculous lymphadenitis by operation, mediastinoscopy and biopsy were evaluated on enhanced CT scan, including 20 men and 19 women. The median age of the patients was 26 years(range from 16-67 years). Results Five post-contrast patterns of enhancement were found: (1) inhomogeneous enhancement(28.3%,51 nodes); (2) peripheral rim enhancement(26.1%, 47 nodes); (3) homogeneous enhancement(25.0%, 45 nodes); (4)nonenhancement( 14.4%, 26 nodes); (5) separate enhancement(6.11%, 11 nodes); CT-pathologic correlation demonstrated that patterns of enhancement of mediastinal tuberculous lymphadenitis were correlated with distribution of granulation tissue and caseous areas. 28 patients(71.8%) had a combination of enhancement patterns. 11 patients(28.2%) had a single enhancement pattern. Conclusion Constrast-enhanced CT appearance of mediastinal tuberculous lymphadenitis for diameter of 1.0-2.0 cm was homogeneous enhancement, nonenhancement, inhomogeneous enhancement and peripheral rim enhancement; for diameter of ≥2.0 cm was inhomogeneous enhancement, peripheral rim enhancement, homogeneous enhancement and nonenhancement. Peripheral rim enhancement or separate enhancement can suggest a diagnosis of tuberculosis.

Objective To evaluate the attitudes of clinical nurses toward caring for the dying patients, and possible influencing factors concerning the attitudes were investigated, so as to provide a scientific basis for further intervention, thus improving the positive attitudes toward care of the dying patients in the future research. Methods A convenience sampling method was used to recruit 770 nurses from 15 hospitals located in 5 provinces in China. A demographic survey, Chinese version of Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B-C) and Chinese version Death Attitude Profile-Revised were employed in the survey. Results FATCOD-B-C scale was used to evaluate the attitudes of nurses toward caring for dying patients, with the mean score of all FATCOD-B-C item being 95.62 ± 7.45. To analyze relationship among demographic variables and the total score of FATCOD-B-C. Univariate analysis revealed that age group (F=2.285), years employed as a nurse (F=3.353), educational background (F=5.581), technical title (F=5.692), level of hospital (t=2.058), religious beliefs (t=-2.788), previous education on death and dying(F=9.743), previous experience in dealing with terminally ill persons (t=2.761) had significant influence on the nurses' attitudes toward caring for dying patients and families(P<0.05). Multiple linear regression analysis indicated that nurses' attitudes toward caring for dying patients had been affected by those factors, among which the most influential factor was educational background. Conclusions It shows that nurses'FATCOD-B-C scores are at a low level. It is suggested to improve nurses' positive attitudes of caring for dying patients and their families by making the specific methods based on the influencing factors, thus improving the development of palliative care.

Objective To construct lentivirus vectors carrying 16 short hairpin RNA (shRNA) expression cassettes targeting histone acetyltransferases and provide a powerful research approach to explore the mechanism of epigenetic genes in regulating hepatitis B virus (HBV).Methods Following the rule of short shRNA primer design,eight-pair primers (A ~ H )for each gene,which had stable interfering efficiency,were designed.The annealed primers were connected to the empty lentiviral vectors of shRNA for transformation.In order to confirm the positive clones,clones were analyzed by real-time polymerase chain reaction (RT-PCR ).Then, qualified plasmids were verified by enzyme digestion technology.Four shRNA lentivirus plasmids against the same gene were mixed to build lentivirus respectively.After the virus transfected into 293T cells for 48 and 72 hours,supernatants were collected to infect HepG2.2.15 cells.The percentage of fluorescent cells were observed and assessed by microscope 72 hours after infection.Results One hundred and twenty-eight lentiviral vectors of RNA interference (RNAi)library were constructed against 16 histone acetyltransferases and more than 80% of HepG2.2.15 cells were infected with lentivirus 72 hours after infection.Conclusions Sixteen shRNA lentivirus vectors against histone acetyltransferase are successfully constructed.Thus,a solid foundation for the study of the effect of human histone deacetylase on HBV replication is established.

Objective:To explore clinical application value of immediate breast reconstruction with silicone prosthesis after nipple areolar sparing mastectomy for breast cancer.Methods:The clinical data of 30 breast cancer patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy from January 2016 to January 2018 were collected. In the observation group, 15 patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy. In the control group, 15 patients underwent conventional modified radical mastectomy only. The differences of operation indicator and postoperative complications between the two groups were compared, and the postoperative cosmetic effects were evaluated.Results:The patients successfully completed prosthetic breast reconstruction in the observation group. The surgical time and indwelling time of the drainage tube in the observation group were both increased compared with the control group, and the difference was statistically significant ( t=118.8 and t=23.9, P<0.05). There were no statistically significant differences between the two groups in the complications of postoperative flap necrosis, subcutaneous hematoma, intraoperative infection and incision dehiscence ( P>0.05). The total complications rate of the observation group was 40%, compared with the control group (20%), there were not statistically significant differences ( P>0.05). The postoperative aesthetic effect evaluation showed that the reconstructed breast was full in shape and basically symmetrical to the contralateral side, with an excellent and good rate of 83.3%. The patients were satisfied with the appearance of the breast. All patients were followed up for 12 to 36 months with the average time of 24 months, and local recurrence and distant metastasis were not observed. Conclusions:In the modified radical mastectomy for breast cancer with preserved nipple and areola, the immediate application of silicone prosthesis for breast reconstruction has the advantages of less trauma, faster postoperative recovery and better cosmetic effect, which is worthy of clinical application.

Objective To study the effect of multi-disciplinary team (MDT) management on the outcome in neonates with omphalocele.Method A retrospective non-randomized controlled clinical study was conducted.Neonates who were diagnosed as omphalocele and admitted to the surgical neonatal intensive care unit of the Guangzhou Women and Children Medical Center from December 2010 to December 2017 were collected.Because MDT was established in December 2014,infants were assigned into non-MDT group and MDT group according to their dates of admission.The characteristics and outcomes between non-MDT group and MDT group were compared using x2,t-test or rank-sum test.Multivariate analysis was performed by Logistic regression.Result A total of 91 neonates were included in the study,50 were in non-MDT group and 41 were in MDT group.The mortality in MDT group (2.4％,1/41) was lower than that in non-MDT group (18.0％,9/50),the difference was statistically significant (P ＜ 0.05).The median time of mechanical ventilation of giant omphalocele in non-MDT group (18.3 hours) was longer than that in MDT group (41.7 hours),the difference was also statistically significant (P ＜ 0.05).After adjusting for the associated confounding risk factors,the risk of death in non-MDT group was 54 times higher than that in MDTgroup (OR=54.19,95％CI2.64 ～1 113.49,P＜0.05).Conclusion There was significant association between the MDT management and the decreased risk of death of omphalocele.

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.