The particularity of physician - patient relationship determines a bilateral ethical regulation is called for in building up the harmony between doctors and patients.Discussion on this matter not only reminds us of pondering on the duality of interpersonal relationship in particular fields,but also demonstrates the necessity and urgency for relevant research on current bilateral ethical regulation.

Displacement ventilation is described from the aspects of its primary principle, characteristics and differences from the traditional one. The factors that have to be taken account into when a displacement ventilation system designed are also discussed.

Objective To study the bioactive components from stems of Schisandra propinqua var. intermedia. Methods Compounds were separated with acombination of multi-chromatography. Their che- mical structures were determined on the basis of spectral analysis and chemical evidence. Results Nine compounds were isolated from S. propinqua var. intermedia. The structures were elucidated as vanillic acid- 4- O-?-D-allopyranoside (Ⅰ), salidroside (Ⅱ), 2-hydroxy-5-(2-hydroxyethyl)-phenyl-?-D-glucopyranoside (Ⅲ), 3, 4-dimethoxyphenyl-4-?-D-glucopyranoside (Ⅳ), 3, 5-dihydroxybenzoic acid-4-O-?-D-glucopyranoside (Ⅴ), 3, 5-dimethoxy-4-hydroxy-benzoic acid (Ⅵ), 4-methoxy-benzoic acid (Ⅶ), vanillic acid (Ⅷ) and protocatechuic acid (Ⅸ). Conclusion Compound Ⅰ is a new phenolic alloside and others are isolated from S. propinqua var. intermedia for the first time.

Objective To investigate the changes and significance of early immune response in specific T cell with invasive pulmonary aspergillosis(IPA) patients. Methods Peripheral blood mononuclear cells (PBMCs) were separated from whole blood of 8 cases of healthy individuals (healthy group) and 24 cases of IPA patients (IPA group, including 6 cases of pathological diagnosis, 9 cases of clinical diagnosis and 9 cases of tentative diagnosis), and the heat-inactivated Aspergillus fumigatus spores (Conidia) was used as an antigen to stimulate PBMCs produce Aspergillus-specific T lymphocytes. Interferon-gamma (IFN-γ) secreation, type and ratio of cytokine synthesis was examined. Results In IPA group, dot enzyme linked immunosorbent assay(ELISPOT) showed that the positive rate of IFN-γin pathological diagnosis patients and clinical diagnosis patients (5/6,7/9) was higher than that in tentative diagnosis patients (3/9). The positive rate of IFN-γin IPA group was 62.5%(15/24), in healthy group was 0 (0/8), and there was significant difference (P<0.05). The levels of CD4+T and CD4+T/CD8+T in IPA group were 0.202 0±0.085 6 and 1.01±0.34, in healthy group were 0.3853±0.1265 and 1.55±0.41. The levels of CD4+T and CD4+T/CD8+T in IPA group were significantly lower than those in healthy group ( P<0.05 or<0.01). The level of CD 8+T in IPA group was 0.298 5±0.069 1, and in healthy group was 0.257 6±0.102 6. The level of CD8+T in IPA group was 05). Conclusion Conidia as antigen can induce the specific Th1-type immune response of IPA, and display the immune status of the IPA patients, and can provide new ideas and methods for the diagnosis and assessment of the disease.

Objective To summarize the perioperative nursing of huge malignant lobulated breast tumor, so as to promote the recovery of patients. Methods A total of 11 patients with huge malignant lobulated breast tumor patients were selected, assessed the preoperative status,finished breast tumor site nursing, strengthen psychological nutritional assessment, the adjustment of the respiratory system for the operation, prevent falls. In addition to do a good job in general nursing and postoperative pain management, but should also focus on the observation of the chest wall flap, drainage tube care, to prevent bleeding and infection, etc. Results By implementing the nursing plan, 1 case of breathing difficulties preoperative patients with respiratory function improved, 1 case of refuse treatment of patients accepted surgical treatment after psychological intervention, 2 cases of postoperative patients with skin flap necrosis, local treatment, after compression bandage, 1 case of good recovery, 1 case of poor treatment effect for the wound recovered well after back surgery graft;1 case of patients with subcutaneous effusion, to adjust the drainage tube, suction fluid, after compression bandage, partial treatment, recovering well. Patients were good recovery, discharged smoothly. Conclusions By constantly sum up experience, through positive assessment of patients after preoperative mental and physical health and attaches importance to patients' skin flap, bleeding, pain, completes the drainage tube nursing and prevention of infection, can effectively promote the recovery of patients.

Objective To analyze the clinicopathologic data and operative parameters of 209 elderly co-lon cancer patients treated by radical resection between January 2002 and December 2011 ,and to investigate the factors related to recurrence and metastasis after colon cancer radical resection in elderly patients .Methods We used univariate and multivariate analysis of Cox regression ,including 14 variables:age,gender,disease duration, hospitalization duration,surgeon experience,operation duration,laparoscopicsurgery,tumor location,tumor size, gross morphology ,differentiate degree ,depth of bowel wall invasion ,lymph node involvement and obstruction .The survival curve was obtained by Kaplan -Meier method.Results Univariate analysis showed that tumor size (RR=2.658,P<0.0001),gross morphology(Infiltrating type,RR=3.407,P=0.0054),degree of differentiation (RR=0.32,P<0.0001) were associated with tumor relapse and metastasis .Multivariate analysis showed that gender(RR=0.585,P=0.0359),tumor size(RR=2.364,P<0.0001),degree of differentiation (Infiltrating type,RR=0.246,P=0.0437),gross morphology(RR=0.31,P<0.0001)were the significant factors.Conclu-sion Gender,tumor size,degree of differentiation,gross morphology were the independent factors of recurrence and metastasis of colon cancer after radical resection in elderly patients .Targeted follow -up for high -risk groups will improve patients′life quality and prolong their survival time .

OBJECTIVE To analyze trimethylation of genome-wide histone H3 lysine 4(H3K4met3) induced by silicon dioxide(SiO2)through chromatin immunoprecipitation linked to microarrays(ChIP-chip)in lung fibroblast(LF)of rats. METHODS A primary co-culture model of rat alveolar macrophages (AM)and LF in vitro. AM were exposed to 100 mg · L-1 free SiO2 for 24 h,before LF were collected and the phenotype of LF was determined after transdifferentiation by immunohistochemistry. ChIP-chip was used to profile the variations of trimethylation in H3K4 of lung fibroblasts in CpG island regions. ChIP-qPCR was used to validate the microarray results. The mRNA expression of nfib and kpna3 was analyzed by qRT-PCR. RESULTS Totally 1815 (518 increased and 1297 decreased) genes of H3K4met3 displayed significant differences in SiO2 100 mg·L-1 group compared with control group(Cy3/Cy5 value>2.0 or <0.5,NimbleScan V2.5 software). The results of ChIP-qPCR were quite consistent with those of microarray. CONCLUSION There are significant differences in methylation of genome-wide H3K4 between SiO2 100 mg·L-1 group and control group. These novel candidate genes may become potential biomarkers or new interfered targets.

Objective:To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer.Methods:Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median . Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results:The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions:Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.

Objective:To explore the recurrence pattern and prognosis of cervical cancer after radical chemoradiotherapy.Methods:Clinical and follow-up data of 1 359 patients with stage Ⅰ-ⅣA (International Federation of Gynecology and Obstetrics 2009 staging) who received radical radiotherapy in Zhejiang Cancer Hospital from August 2011 to December 2017 were retrospectively analyzed. The survival and prognostic factors of 249 patients with recurrence / metastasis with detailed data were analyzed. The primary endpoint was post-recurrence / metastasis survival time. Kaplan-Meier method was used to calculate the survival rate, log-rank test was used for single factor analysis, and Cox model was used for multi-factor analysis.Results:The distant metastasis rate of 249 patients was 77.5%, and the local recurrence rate was 36.9%. According to the location of metastasis and recurrence, 56 cases with recurrence in the field of radiotherapy alone were assigned into group A, 157 cases with recurrence outside the radiation field alone were allocated into group B (56 cases with lymph node recurrence in group B1, 78 cases with blood metastasis in group B2, and 23 cases with lymph node and blood metastasis simultaneously in group B3), and 36 cases with combined recurrence and metastasis in and out of the field of radiotherapy were assigned into group C. The median survival time of patients in groups A, B1, B2, B3 and C was 13, 24, 13, 11 and 9 months, respectively (all P<0.001). According to the interval from initial diagnosis to recurrence / metastasis, 110 cases were classified in ≤1 year group, 74 cases in >1-2 years group, and 65 cases in >2 years group. The median survival time of patients in the three groups was 11, 14, and 22 months, respectively (all P<0.001). According to the management of recurrence / metastasis, 138 cases received palliative treatment, 15 cases received local treatment, 45 cases received systemic treatment, and 51 cases received combined treatment. The median survival time of patients among four groups was 9, 37, 20 and 32 months, respectively (all P<0.001). The results of multi-factor analysis showed that age, recurrence / metastatic site, retreatment methods, time interval between initial treatment and recurrence /metastasis were the independent prognostic factors affecting the survival (all P<0.05). Conclusions:Distant metastasis is the main failure pattern after radical radiotherapy. Patients with metastasis out of irradiated regions, especially those with only lymph node metastasis, have good prognosis. Active retreatment and time interval between initial diagnosis and recurrence / metastasis are important prognostic factors.

The efficient clinical treatment of oral squamous cell carcinoma(OSCC)is still a challenge that demands the development of effective new drugs.Phenformin has been shown to produce more potent anti-tumor activities than metformin on different tumors,however,not much is known about the influence of phenformin on OSCC cells.We found that phenformin suppresses OSCC cell proliferation,and promotes OSCC cell autophagy and apoptosis to significantly inhibit OSCC cell growth both in vivo and in vitro.RNA-seq analysis revealed that autophagy pathways were the main targets of phenformin and identified two new targets DDIT4(DNA damage inducible transcript 4)and NIBAN1(niban apoptosis regulator 1).We found that phenformin significantly induces the expression of both DDIT4 and NIBAN1 to promote OSCC autophagy.Further,the enhanced expression of DDIT4 and NIBAN1 elicited by phenformin was not blocked by the knockdown of AMPK but was suppressed by the knockdown of transcription factor ATF4(activation transcription factor 4),which was induced by phenformin treatment in OSCC cells.Mechanistically,these results revealed that phenformin triggers endoplasmic reticulum(ER)stress to activate PERK(protein kinase R-like ER kinase),which phosphorylates the transitional initial factor eIF2,and the increased phosphorylation of eIF2 leads to the increased translation of ATF4.In summary,we discovered that phenformin induces its new targets DDIT4 and especially NIBAN1 to promote autophagic and apoptotic cell death to suppress OSCC cell growth.Our study supports the potential clinical utility of phenformin for OSCC treatment in the future.