Object To investigate the synthesis of alkaloids by cell suspension cultures of Datura metel L. Methods Cultured cells derived from leaves of D. metel were m aintained in Murashige and Skoog (MS) liquid medium. The effects of different c arbohydrated, different inoculum sizes, and different pH values of medium as aff ecting facters on cell growth and alkaloid formation were studied. Re sults The optimum carbohydrate was sucrose, inoculum size (1.5 - 2. 0 g/L) for fresh weight and initial pH values (5.5-6.0) of the medium were benefit for cell growth and alkaloid synthesis in the suspension cultures. The synthesis of alk aloids was improved when exogenous phenylalanine added to the culture. Conclusion Suspension-cultured cells of D. metel c an be used to synthesize alkaloids.

Objective Lung cancer has been the most common cause of cancer death worldwide.More than three quarters is diagnosed at advanced stage.Nearly one half has distant metastases outside the chest cavity.It has been recognized that oligometastatic state exists in natural history of malignant tumors,which has significantly better prognosis than those with polymetastases.The eighth edition of TNM staging system defined NSCLC with a single metastasis as a new separated stage(M1 b).Long-term survival of oligometastatic NSCLC patients treated with local control methods has been reported in literatures.But whether surgical resection of liver metastasis has benefit or not remains unknown.We performed a systematic review of surgical therapy for NSCLC with limited liver metastases.

Objective The analysis healthy crowd skull magnetic resonance image formation(MRI) inspection result,understood healthy crowd skull common disease the type,favors the healthy physical examination project the reasonable establishment.Methods Medical Center sent medical examination of 380 cases of brain MRI data and retrospective analysis.Results 380 cases of brain MRI results show healthy physical examination:there are 9 kinds of disease,MRI exception occurred there were 109 cases,abnormal rate of 28.7％ ; by age is divided into three groups:30-40 sui,41-50 sui; 51-60 sui; 51-60 sui exception rate was highest in the age group,to 56.9％ ; the discovery of the disease,the highest incidence of disease with multiple lacunar cerebral infarction,73.4％ per cent of total incidence.Conclusion MRI no radiation,brain MRI examination should as a general project of middle and old aged healthy,early detection of brain tumor lesions and cerebral vascular lesion,disease prevention and healthy living for guidance.

Objective:To investigate the relationship between sarcopenia and early renal dysfunction in elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 198 elderly patients with T2DM aged over 60 years undergoing treatment in the Geriatric Department of Beijing Hospital from July 2018 to July 2019 were enrolled in this retrospective case-control study.The estimated glomerular filtration rate(eGFR)is calculated according to the CKD-EPI Cr-Cys formula.Based on the eGFR, the patients were divided into normal renal function group(n=63, in CKD 1 stage)and mild renal dysfunction group(n=135, in CKD 2-3a stage). All subjects underwent physical examination, laboratory examination and dual energy X-ray bone density examination. Results:The age, weight, body mass index, abdominal circumference, serum creatinine, cystatin C, uric acid, diastolic pressure, the proportions of diabetes and hypertension were lower, and the high-density lipoprotein cholesterol, appendicular skeletal muscle mass(ASM)and skeletal muscle mass index(SMI)were higher, in the normal renal function group than in the mild renal dysfunction group( P<0.05 or 0.01). Spearman correlation analysis showed that eGFR was positively correlated with SMI( r=0.343, P<0.01). Logistic regression analysis showed that body weight( OR=1.318, 95% CI: 1.091-1.594), uric acid( OR=1.007, 95% CI: 1.001-1.012), diastolic blood pressure( OR=1.072, 95% CI: 1.033-1.112), years of diabetes( OR=1.075, 95% CI: 1.013-1.142)were risk factors, and the LSM( OR=0.136, 95% CI: 0.047-0.392)and SMI( OR=0.778, 95% CI: 0.703-0.860)were protective factors for the early renal dysfunction in elderly patients with T2DM. Conclusions:Elderly patients with T2DM are often co-existed with sarcopenia.Sarcopenia is associated with early renal dysfunction in elderly patients with T2DM.

With the acceleration of the aging process in China, the incidence rates of coronary heart disease and cerebral infarction have significantly increased.And iodine contrast agent is often used in imaging diagnosis and percutaneous intervention therapy.The contrast medium is filtered from the glomerulus in its original form and is not absorbed by renal tubules.However, the accumulation of iodine contrast medium in the kidney can lead to acute kidney injury.Kidney is one of the most important excretory and endocrine organs in human body.The prevention and treatment of contrast-induced nephropathy(CIN)have been widely concerned.The incidence rate of contrast-induced renal damage is higher and the prognosis is poorer in the elderly than in the non-elderly due to the decline of organ function in the elderly.At present, the mechanism of action for oxygen free radicals in CIN of the elderly is still unclear.This article reviews the researches on the role of oxygen free radical in CIN of the elderly studied by domestic and foreign scholars in recent years.

Quality management covers every corner of hospital services,which upholds full-process quality management,continuous quality improvement and smooth management with patients at the center.By means of building a 3-tier quality management framework at the hospital,development of quality management criteria,appraisal indicators and documentation and use of quality management tools,quality management defects were identified from a third-party perspective.This effort has significantly improved quality of care at the hospital,and elevated the management execution and general service quality of the hospital.

Objective To examine the effect of ultrasonic debridement combined with continuous skin stretching to repair refractory infective wound bed.Methods From January 2016 to July 2016,we treated 15 cases of chronic,refractory infective wound beds using ultrasonic debridement combined with skin stretching technique.Results All the 15 (100％) cases were cured without necrosis of the stretched skin edges.Conclusions Ultrasonic debridement combined with continuous skin stretching is an appropriate technique for repairing the refractory wound bed in the patients who are older,in poor general condition,or poor condition of local skin and soft tissue,or have poor postoperative effect,or surgical contraindication or at higher risk of surgery.

Objective: To summarize the effect of propeller flap pedicled with cutaneous branch of digital artery for skin defect at children’s thumb tip. Methods: From December 2012 to October 2015, 12 children with skin defects at thumb tip were treated. The nail matrix was kept in 4 cases, partly injuried in 8 cases. The skin defects size ranged from 1.0 cm×1.0 cm to 1.5 cm×2.0 cm, all more than the size of nail roots. A triangular flap on lateral side of thumb was designed with cutaneous branch of digital artery on thumb ulnar side at wound edge. The defects at donor sites were covered with skin grafts. Results: The flap size ranged from 1.0 cm×1.0 cm to 1.5 cm×2.0 cm. All the flaps and skin grafts survived with primary healing. The children were followed up for 6-12 months(average, 8 months). The flaps had soft texture and good color match and thickness. The cosmeticresult was satisfactory with normal nail growth. According to the standard of the hands of the Chinese Medical Association functional evaluation trial, the hand function was assessed as excellent in 9 cases, good in 3 cases 6 months after operation. Conclusions Propeller flap with cutaneous branch of digital artery is suitable for the skin defect at children’s thumb tip with both satisfactory cosmetic and functionalresult . Themethod is easily performed with reliable venous drainage and less morbidity.

Objective To explore the clinical application value of 64-layer spiral CT three-dimensional imaging in sty-loid process syndrome. Methods Imaging data of three-dimensional imaging of 42 patients with styloid process syn-drome who were examined from 2013 to 2014 were collected and retrospectively analyzed. The thickness and spacing of scanning layer were both 1 mm, and the tread pitch was 1. Reconstruction techniques of MIP and VR were applied for processing. Results Three-dimensional images of 42 patients(MIP image,VR image)all distinctly manifested the over-all picture of styloid process and imaging findings. Conclusion The combined application of MIP and VR reconstruc-tion techniques, as well as the comprehensive analysis of axial imaging are able to significantly improve the accurate diagnosis of styloid process syndrome via spiral CT, which provides significant values for clinical diagnosis of diseases and surgery.

Objective:To systematically review the efficacy and safety of new oral anticoagulants(NOACs)for the treatment of patients over 70 years with atrial fibrillation.Methods:Studies comparing NOACs(dabigatran, rivaroxaban, apixaban, ximelagatran and edoxaban)versus warfarin for the treatment of patients over 70 years with atrial fibrillation were searched through databases including PubMed, Embase and the Cochrane Library, from the earliest electronic records to those published in March 2021.Stata15.0 software was used for meta-analysis.Results:A total of 19 studies and 215 471 patients were included.Meta-analysis results showed that, compared with warfarin, either a low-dose(110 mg)or a standard-dose(150 mg)of dabigatran reduced the risk of stroke/systemic embolism(SSE)in patients over 70 years with atrial fibrillation.A standard-dose of dabigatran did not decrease the risk of major bleeding, but a low dose was able to achieve it.A standard-dose(20 mg)of rivaroxaban could considerably reduce the risk of SSE in geriatric patients over 70 years with atrial fibrillation without increasing the risk of major bleeding.A standard-dose(5 mg)of apixaban could considerably decrease the risk of SSE and major bleeding in patients over 70 years with atrial fibrillation; A standard-dose(36 mg)of ximelagatran was as effective as warfarin in decreasing the incidence of SSE in patients over 70 years with atrial fibrillation, but could also considerably decrease the risk of major bleeding; A low-dose(15-30 mg)or a standard-dose(30-60 mg)of edoxaban decreased the incidence of SSE in patients over 70 years with atrial fibrillation, as did warfarin, but edoxaban considerably decreased the risk of major bleeding.Conclusions:Compared with warfarin, most of new oral anticoagulants show good efficacy in patients over 70 years old with atrial fibrillation, NOACs given at standard doses increase the risk of major bleeding, but at low doses can realize both efficacy and safety.