The lymphonodus cervicothoracious and lumbaris of 19 Pekin ducks were studied using the histological methods. The lymph nodes are consisted of the capsule, loose areas, and dense areas. There are lymphatic tissue cords, connective tissue cords and intercord lymph sinus and lymphatic nodules also in the loose areas. The dense area are consisted of lymphatic nodules and mass of lymphoid cells. The lymphatic nodules are irregularly distributed and no germinal centers. The lymph sinuses may be classified into the central sinus and peripheral sinus. The latter may be subdivided into subcapsule sinus, paralymphonodular sinus and the intercord lymph sinus. There are reticular cells in the intercord lymph sinus. No true trabeculae are present but there are many blood vessels and nerves in the lymph nodules.

The development of acupuncture in Australia has been booming.Under this circumstance,a series of acupuncture standards,codes and guidelines were established by different associations of TCM in Australia.Moreover,Australia has set the front pace in the field of acupuncture standards among the countries outside China.This paper is to introduce the acupuncture standards of Australia in three aspects respectively:national standards,industry standards and regional standards and to generalize the content of the main standards as well as analyze the current condition of Australian acupuncture standardization in order to generally give an all-around view of Australian acupuncture standards to the researchers in the field of international acupuncture standards.

The standardization of acupuncture and moxibustion in Canada is increasingly flouring nowadays:on one hand,acupuncture industry in legislated provinces is in the charge of direct administrative departments and associations of acu-moxi; on the other hand,according to the local situations,relevant regulations have been made,which are concentrated on two aspects-technical and administrative standards.Undoubtedly,Canadian Alliance of Regulatory Bodies for TCM Practitioners and Acupuncturist (CARB),united by each provincial TCM/Acupuncture Administration,is the first step to issue federal standards and establish federal level management institution.However,now the releasing of a fundamental regulatory file is in need of active corporation and publicity from each province and association.Therefore,it shows that the body of standardization in Canada is still not relatively perfect.Through introducing and analyzing the relevant information,the author expects that the readers can know the current development of acupuncture and moxibustion standardization in Canada.

Objective To explore the feasibility of evaluating cardiac structure, coronary artery,pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. MethodsForty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was (71.2 ± 11.2) beat per min (bpm). No arrhythmia case included. Results ( 1 ) Pulmonary embolism were diagnosed in 11 cases,coronary artery disease (CAD) were found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. (2) The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were (36.7 ±3.3), (43.3 ± 3.4) mm,(31.6±5.1), (41.3 ±5.1) mm and (47.1 ±15.1) for CT, while those were (40.3 ±3.1), (47.3 ±4.2) mm,(37.3 ±5.6), (45.3 ±3.3) mm,and (46.0 ± 14.8) for ultrasound, respectively. The CT results were correlated with the ultrasound ( n = 35, r = 0.886-0.988, P ＜ 0.01 ). (3) The average radiation exposure was ( 5.4 ± 0.5 ) mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the "one-stop-shop" examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.

Objective To investigate the diagnostic value of dual-energy CT pulmonary angiography (DE-CTPA) and dual-energy CT lung perfusion (DE-CTLP) in the assessment of pulmonary embolism comparing with pulmonary ventilation-perfusion scintigraphy. Methods Fifty patients suspected of PE (26 males, 24 females) underwent both DE-CTPA, DE-CTLP and pulmonary ventilation-perfusion scintigraphy. The results were compared and the correlation between the intravascular clots in DE-CTPA and the perfusion defects in DE-CTLP was analyzed. The sensitivity, specificity and accuracy of DE-CTLP for PE were assessed according to scintigraphic results which was considered as a "gold" standard. Result ( 1 ) Of 50 cases,920 segments in 46 cases were diagnostable, 4 cases were not included because of the poor image quality. lntravascular clots were found in 262 segments on DE-CTPA and perfusion defects in 266 segments were identified on DE-CTLP, while 268 segments were positive on scintigraphy. (2) The perfusion defects on DE-CTLP were correlated well with the clots on CTPA ( r = 0. 883, P < 0. 01 ). The Dual energy CT Lung perfusion imaging had a good consistence with scintigraphy (Kappa = 0. 940, P <0. 01 ). The sensitivity, specificity, positive and negative predictive value were 96. 2% (279/290), 98.0%(641/654), 95. 5% (279/292) and 98. 3% (641/652), respectively. (3)The radiation dose of DE-CTPA and CE-CTLP scan was(4. 37 ± 0. 47) mSv by using CareDose 4D technique. Conclusion DE-CTPA and CE-CTLP can provide pulmonary vascular morphology and parenchyma perfusion information which are useful and valuable for the diagnosis of PE.

Objective To investigate and analyze the antimicrobial unreasonable use of antibacterial drugs in the com-munity center and to explore the corresponding countermeasures according to the reasons in order to accumulate experi-ence for promoting the rational use of drugs. Methods A total of 27 community health centers in the city were randomly selected as the research object and 50 antibiotic prescriptions, randomly selected among the antibiotic prescriptions is-sued in every community health center in the year 2012, were checked. The unreasonable use of antibacterial drug was classified, summarized and analyzed in the audit process. The corresponding countermeasures were explored according to the causes of the irrational use of antibiotics and changes of the irrational use of antibiotics were compared before and after the implementation of countermeasures. Results 293 copies of antibiotic prescriptions among the 1350 copies of antibiotic prescriptions randomly selected in 2012 were found unreasonable after the review, which accounted for the entire21.7% of the prescribed doses. Among the 293 copies of antibiotic prescriptions, the unreasonable choice of an-tibacterial drug accounted for 13%, the irrational drug use combined with other drugs accounted for 20.8% and drugs repeatedly used accounted for 9.2%, unreasonable solvents accounted for 18.8% and the usage and amount of drugs, which were unreasonable, accounted for 38.2%. After the implementation of standard medication strategy in 2013, the rate of irrational drug use was significantly lower than that in 2012 (9.3% vs 21.7%,χ2=78.9,P<0.05). Conclusion Through the analysis of the statistics of irrational drug use in the community health center, the appropriate regulatory measures have been planed, which has laid the foundation for the choice of suitable antibiotics and adopt suitable medication method and has guaranteed the rationality and the scientific nature of clinical use of drugs.

Cholelithiasis is a kind of common and multiple diseases.In recent years,traditional laparotomy has been challenged by a minimally invasive surgery.Through literature review,the therapeutic method,effect,and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows.(1) For intrahepatic bile duct stones,the operation may be selected by laparoscopic liver resection,laparoscopic common bile duct exploration (LCBDE),or percutaneous transhepatic cholangioscopy.(2) For concomitant gallstones and common bile duct stones,the surgical approach can be selected as follows:laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation,LC plus laparoscopic transcystic common bile duct exploration,LC plus LCBDE,and T-tube drainage or primary suture.(3) For concomitant intrahepatic and extrahepatic bile duct stones,laparoscopic liver resection,choledochoscopy through the hepatic duct orifice on the hepatectomy cross section,LCBDE,EST,and percutaneous transhepatic cholangioscopic lithotripsy could be used.According to the abovementioned principle,the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Traditional Chinese Medicine (TCM) products could be registered as natural health products (NHPs) in Canada. Its registration process could be mainly divided into simple-application, traditional-application and non-traditional application. By analyzingi the TCM registration evidence system and its safety, effectiveness and quality required by different registration categories in Canada, we found that "simple-application" procesure needs to submit evidence based on the parameters of a component in the monograph. As for "traditional application", TCM products need to be used at least 50 years with, traditional material or Pharmacopoeia can be used as evidence; As for non-traditional application, TCM products need to provide evidence according to the disease risk level, and most of them need to provide scientific experiment evidence. Therefore, from the experience of TCM registration evidence system in Canada, the registration of TCM products should pay attention to improve the its classification method, refining its evidence requirements and data types, promoting the formulation of monograph of TCM, realizing the scientific evaluation and rapid review of classic famous prescriptions, and promoting the inheritance and innovative development of TCM in China.

Objective:To study the clinical efficacy of surgical resection combined with iodine-131 ( 131I) therapy in elderly patients with differentiated thyroid cancer and its influence on complications. Methods:Totally 82 elderly patients with differentiated thyroid cancer who were admitted to Chengde Central Hospital from March 2019 to March 2021 were selected and divided into observation group (41 cases) and control group (41 cases) according to the random number table. The control group underwent total thyroidectomy + neck lymph node dissection, and the observation group was treated with 131I after the operation on the basis of the control group. The indicators in the two groups were evaluated (postoperative observation time cutoff was 3 months), including perioperative indexes, postoperative complications, Karnofsky (KPS) score, serum levels of lymphocyte activating gene-3 (LAG-3) and recombinant human Dick-kopfx related protein-1 (DKK-1) before and after treatment, and the efficacy. Results:There was no significant difference between the two groups in the amount of intraoperative bleeding and operation time ( P > 0.05); the hospitalization time in the observation group [(6.72 ± 1.39) d] was shorter than that in the control group [(8.78 ± 1.43) d, P < 0.001]. The incidence of complications in the observation group (31.71%, 13/41) was lower than that in the control group (53.66%, 22/41, P = 0.045). After treatment, KPS scores in the two groups were higher than those before treatment ( P < 0.001); after treatment, KPS score in the observation group was higher than that in the control group ( P < 0.001). After treatment, the serum LAG-3 levels in the two groups were higher than those before treatment, while DKK-1 levels were lower than those before treatment ( P < 0.001); after treatment, the serum LAG-3 level in the observation group was higher than that in the control group, while the DKK-1 level was lower than that in the control group ( P < 0.001). The total effective rate of the observation group (95.12%, 39/41) was higher than that of the control group (80.49%, 33/41, P = 0.043). Conclusion:The clinical efficacy of surgical resection combined with 131I therapy in elderly patients with differentiated thyroid cancer is good, and it can reduce postoperative complications, up-regulate the expression of LAG-3 and down-regulate the expression of DKK-1.

Objective:To evaluate the nutritional status of patients with decompensated liver cirrhosis and explore the correlation with malnutrition and the risk factors of depressed mood.Methods:190 cirrhotic patients admitted to the Department of Gastroenterology of the First Hospital of Shanxi Medical University from June to September 2023 were selected according to the inclusion and exclusion criteria. Eligible patients were divided into subgroups based on the presence or absence of malnutrition as determined by subjective global assessment (SGA). The Center for Epidemiological Studies Depression (CES-D) scale was used to assess patients' propensity for depressed mood. Relevant clinical data were also collected and analyzed.Results:A total of 185 patients were included, of which 126 were in the non-malnutrition group and 59 malnutrition group. There were significant between-group differences in terms of CES-D results, age, body mass index, platelets, D-dimer, serum sodium, third lumbar skeletal muscle index, grip strength, triceps skinfold thickness, and upper arm muscle circumference (all P<0.05). Correlation analysis showed that grip strength, triceps skinfold thickness, upper arm muscle circumference, serum sodium, and depressed mood tendency status were correlated with the development of cirrhotic malnutrition ( P<0.05). The diagnostic model for malnutrition in cirrhosis using these five indicators showed the area under the curve of 81.9%. Conclusions:Depression is closely related to the development of malnutrition in patients with liver cirrhosis. Independent risk factors for malnutrition in cirrhosis include serum sodium≤135 mmol/L, grip strength, triceps skinfold thickness, lower-than-normal upper arm circumference , and the tendency of depression , which demonstrate the combined contribution to the diagnosis of malnutrition in cirrhosis.