PURPOSE: The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF. METHODS: Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models. RESULTS: Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management. CONCLUSION The nomogram accurately predicted POPF in patients having PD.

Objective The relationship between circular RNAs (circRNA) and lung adenocarcinoma (LAC) remains to be further explored. This study aimed to investigate the expression of Hsa_circ_0002360 in LAC and its value in the clinical diagnosis and treatment of the malignancy. Methods This study included 50 cases of LAC treated in our hospital from May 2018 to June 2019 and another 50 healthy subjects as normal controls. We determined the expression of Hsa_circ_0002360 in the LAC cells by qRT⁃PCR. We cultured human LAC cell lines A549, H1299 and H1975 and human bronchial mucosal epithelial cell line BEAS-2B, inoculated the A549 and H1975 LAC cells in the 6-well plate, with 3 wells for si-circRNAs and the other 3 for negative controls (si-NC), followed by cell transfection experiment. Using the CCK8, colony formation and wound healing assays, we detected the effects of Hsa_circ_0002360 on the activity, proliferation, invasiveness and metastasis of the A549 and H1975 cells. Results The expression of Hsa_circ_0002360 was significantly higher in the LAC tissue than in the adjacent tissue (2.84 ± 0.12 vs 1.46 ± 0.08, P < 0.01), and so was it in the serum of the LAC patients than in the normal controls (2.59 ± 0.17 vs 1.21 ± 0.11, P < 0.01), but remarkably lower in the serum of the patients after than before surgery (1.58 ± 0.09 vs 2.65 ± 0.13, P < 0.01). Besides, its expression was significantly increased in the LAC A549, H1299 and H1975 cell lines compared with that in the BEAS-2B cells (P < 0.05). In comparison with the si-NC group, the si-circRNA group showed significant decreases in the rates of colony formation ([65.66± 4.93]% vs [38.33 ± 1.69]%, P < 0.01) and migration of the cells ([54.66±4.10]% vs [13.50 ± 3.34]%, P < 0.01) and in the count of H1975 cells as well (P < 0.01). Conclusion Hsa_circ_0002360 can be used as a biomarker for the early diagnosis and treatment of lung adenocarcinoma.

OBJECTIVE: To evaluate the comprehensive technical efficiency of the tertiary public hospitals in Beijing between 2006 and 2015 and explore its influencing factors, so as to propose corresponding policy suggestions. METHODS: The data envelopment analysis was employed to evaluate the comprehensive technical efficiency, pure technical efficiency and scale efficiency of the tertiary public hospitals in Beijing. Malmquist index model was used to analyze the changes of the above three dynamic efficiencies. Finally, randomeffect panel tobit model was utilized to analyze the influencing factors of the comprehensive technical efficiency. RESULTS: The average comprehensive technical efficiency and pure technical efficiency of the tertiary public hospitals in Beijing were relatively high, and they had respectively increased from 0.44 and 0.51 in 2006 to 0.62 and 0.68 in 2015, and the highest proportion of two kinds of efficiency values was between 0.5 and 0.8. Most of the scale efficiency values distributed between 0.8 and 1.0, and the majority of hospitals were in a state of decreasing returns to scale. The total factor productivity of hospitals had been increasing at an average rate of 5.78% per year due to the double progress of technical efficiency and technology at annual rates of 3.77% and 1.94% respectively, further decomposing technological efficiency change, and the pure technical efficiency change increased at the speed of 3.21% per year, and the annual average rate of progress in scale efficiency was only 0.53%. The comprehensive technical efficiency was positively correlated with the turnover rate of beds, annual visits per doctor, the ratio of doctors to nurses, and negatively correlated with the number of beds, the ratio of outpatients to inpatients, the proportion of medical technical personnel, and the proportion of drugs. CONCLUSION Future health policies should strictly control the scale of tertiary public hospitals, pay attention to the innovation and application of hospital technology, change the hospital internal management level and management model, promote refined management, and achieve sustainable development.
Efficiency, Organizational ; Hospitals, Public

The fluoritum is used for gynecology frequently and it's for those diseases: kidney yang deficiency, Gong cold sterility, palpitation due to fright, insomnia and dreaminess and cold cough. It's ruled in Chinese Pharmacopoeia (1985 edition) that the fluoritum originates from fluorite which belongs to fluoride minerals. Its main content is CaF2. The colors are of differents grades with purple or green. In the market, there are large differences in quality and it has various colors. Besides of the ruled color of purple and green, white and yellow are also common colors. By digging into and analysis the relevant research literature of fluorite which belongs to fluoride minerals, colors and coloration mechanism of fluorite are summarized in this paper.Natural fluorite is the mineral which has the most species of colors in nature. The different colors of fluorite are mainly caused by the impurity elements. At present, there are mainly about the coloration mechanism of fluorite: rare earth ions (4fN ions), color center, inclusions, crystalline domains or sub microscopic inclusions. The green of fluorite is produced by 570 nm and 305 nm absorption peaks which are caused by Sm2+ and compensated ions Na+ centers generated color center. The yellow of fluorite is produced by the joining of transition element, resulting in the formation of charge transfer between the crystal ions and the formation of O2-O32- ion molecule.The black of fluorite, mainly was attributed to the existence of a higher degree of evolution of organic matter. In this passage,suggestions for modification of the properties of fluoritum in Chinese Pharmacopoeia are put forward.

BACKGROUNDWarfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation (AF). There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF (NVAF). The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy.

METHODSFrom January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate (eGFR) was calculated from baseline and follow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a ≥25% decline in eGFR (hereafter, endpoint), while Cox models estimated hazard ratios (HR s) and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a ≥25% decline in eGFR.

RESULTSAfter a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin (n = 655) and no anticoagulation groups (n = 296) and 120 (12.6%) patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups (χ2 = 0.178, log-rank P= 0.67), but patients with systolic blood pressure (SBP) <140 mmHg have significant difference with patients with SBP ≥140 mmHg (χ2 = 4.903, log-rank P= 0.03). Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HR s of 1.00, and 1.02, respectively.

CONCLUSIONIn patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.

TRIAL REGISTRATIONChinese Clinical Trial Registry (No. ChiCTR-OCH-13003729); http://www.chictr.org.cn/showproj.aspx?proj = 5831.

Aged ; Anticoagulants ; adverse effects ; therapeutic use ; Atrial Fibrillation ; drug therapy ; physiopathology ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Kaplan-Meier Estimate ; Kidney ; drug effects ; Male ; Middle Aged ; Prospective Studies ; Warfarin ; adverse effects ; therapeutic use

Based on traditional acupuncture-moxibustion treatment ideas, with differentiation of channels and collaterals as main part and feature, the important role of associated symptom and sign-based acupoint selection in acupuncture-moxibustion treatment is explained from angles of philosophy and medicine. Combined with clinical experience of acupuncture and moxibustion, the category of associated symptom and sign-based acupoint selection is explained in detail to make sure the accuracy of acupuncture-moxibustion differentiation. It could show uniqueness and advantage of theory and clinic in acupuncture-moxibustion and provide theoretical references in making acupuncture-moxibustion prescription to improve effectiveness of clinical treatment.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Moxibustion

To synthesize salbutamol immunogen and develop an enzyme immunoassay (ELISA), a new salbutamol immunogen was synthesized using 4-aminobenzoic acid as a linker to connect hapten with carrier protein. An enzyme immunoassay based on the antibody prepared was developed and applied to detect salbutamol residue spiked in swine liver. An unusual coating antigen, clenbuterol-ovalbumin (OVA) conjugate instead of salbutamol-OVA conjugate, was used in the immunoassay and the results were discussed based on the structures of related compounds. The antibodies showed high sensitivity in the heterologous assay when using clenbuterol-OVA as a coating antigen, with an IC50 value of 8.97 ng mL(-1) toward salbutamol. The antibodies prepared showed high cross-reactivity with clenbuterol (107%) and were promising for the simultaneous determination of salbutamol and clenbuterol residues in food and food products. Recovery rates from the salbutamol-spiked swine liver samples were in the range of 70%-99%, while the intra-assay and inter-assay coefficients of variation were <13.3% and <14.3%, respectively. In summary, the antibodies of salbutamol have been successfully prepared. Sensitive and stable analysis for the detection of salbutamol residues in swine liver was obtained based on the competitive ELISA methods developed in this study.
4-Aminobenzoic Acid ; chemistry ; Adrenergic beta-Agonists ; analysis ; immunology ; Albuterol ; analysis ; immunology ; Animals ; Antibodies ; immunology ; Antibody Specificity ; Clenbuterol ; analysis ; immunology ; Drug Residues ; analysis ; Enzyme-Linked Immunosorbent Assay ; methods ; Food Contamination ; Haptens ; immunology ; Immunization ; Liver ; chemistry ; Male ; Ovalbumin ; chemistry ; immunology ; Rabbits ; Serum Albumin, Bovine ; chemistry ; immunology ; Swine