Objective To investigate the diagnostic value of EBUS imaging features for metastatic mediastinal/hilar lymph node enlargement in lung cancer.Methods The lung cancer patients with a pathological diagnosis and without preoperative anti-tumor treatment who got the EBUS-TBNA examination from October 2009 to September 2011 were retrospectively analysis.422 lung cancer patients with 683 mediastinal / hilar lymph nodes were enrolled in this study,including 335 males and 87 females; the median age is 61 years old (range 24-82),EBUS lymph node ultrasound image and the final pathological or follow-up results were compared by the statistical analysis.Homogeneity in the lymph node EBUS image feature was defined as:uniform echo in the ultrasound images,cortex existed in the peripheral areas,medulla existed in lymph central with a slightly stronger echo and represent as a small strip.Heterogeneity was defined as: the ultrasound image was defined as uneven echo involved with coagulation necrosis sign,which was the hypoechoic areas without blood flow in the lymph nodes and represent no blood flow in the CDPI mode.The coagulation necrosis was associated with necrosis within the lymph node.In addition,if the CNS region occupied more than 11％ of the entire lymph node in a complete lymph node or just a part of huge lymph nodes in the EBUS imaging window frame,we also regard it as heterogeneity.If a complete lymph node was seen in the EBUS imaging window frame,we measured the longest diameter to the long axis and its vertical maximum diameter to the short axis.If the lymph node was huge and extended the EBUS imaging window frame,we measured the longest diameter in the frame as the long axis of its vertical maximum diameter to be the short axis.As to the EBUS-TBNA negative lymph nodes,we regarded it was malignant lymph node if the diameter of the lymph node increased by 20％ in the patients who did not received any chemotherapy or radiotherapy or the diameter of the lymph node increased or decreased by 20％ in the patients who received any chemotherapy or radiotherapy six month later in the chest enhanced CT scan,otherwise,it was identified as benign lymph node.We used the RECIST 1.1 solid tumors criteria to evaluate the efficacy of the chemotherapy.Results 422 patients were enrolled this study including 93 squamous carcinomas,137 adenocarcinomas,97 small cell lung cancer,42 poorly differentiated non-small cell lung cancer,29 adenosquamous carcinoma and 24 other malignant tumors (including large cell carcinoma,sarcomatoid carcinoma,carcinoid tumors,etc).The sensitivity of the EBUS-TBNA was 93.8％ (396/422).The diagnostic methods and results in the 683 lymph nodes were as the following: 506/683 (74.1％) was confirmed as cancer by the EBUS-TBNA while 177/683 (25.9％) was diagnosed as benign disease.Among these,32/683 (4.7％) was confirmed as cancer and 57/683 (8.3％)was confirmed as benign disease by surgery,9/683 (1.3％) was confirmed as cancer and 79/683 (11.6％) was confirmed as benign disease by the method of follow-up.the sensitivity for the EBUS-TBNA to be malignant was 506/547 (92.5 ％),specificity was 136/136 (100％),positive predictive value was 506/506 (100％),negative predictive value was 136/177(76.8％) and accuracy was 642/683 (94.0％).The short axis diameter in the 683 lymph nodes ranged from 0.40cm to 4.60cm with an average diameter of (1.58 ± 0.68) cm.Among them,the short axis diameter in the malignant lymph node was (1.75 ± 0.63) cm,and in the benign lymph nodes was (0.92 ± 0.40) cm.527 lymph nodes presented heterogeneity under the ultrasound imaging,in which,519/527 (98.5 ％)were malignant lymph nodes.While,156 lymph nodes presented homogeneity and 28/156 (17.9％) were malignant lymph nodes (x2 =489.5,P ＜0.01).In the heterogeneous lymph node with a short axis diameter more than 1.0cm,the sensitivity to be malignant was 89.4％,specificity was 100％ and accuracy was 89.6％.In the homogeneous lymph node with a short axis diameter less than 0.8cm,the sensitivity to be benign was 43.8％,specificity was 67.8％ and accuracy was 48.1％.Conclusion EBUS-TBNA is new biopsy method for the mediastinal / hilar lymph node.The classification based on EBUS imaging-based lymph node ultrasound image features was helpful to identify the procedure for the diagnostic purposes and could help to distinguish the benign or malignant mediastinal / hilar lymph node in lung cancer patients.

Objective To evaluate the diagnostic role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the smear and culture negative tuberculosis.Methods The tuberculosis suspected patients with spu-tum-negative for three times and with hilar or mediastinal lymphadenopathy were randomly divided into 2 groups,study group received EBUS-TBNA and bronchoalveolar lavage group(BAL) examination,control group received BAL examination only.Chi-square test was used to compare their diagnostic sensitivity and negative predictive value.Results Totally 82 patients were included this study,40 patients were in control group and 42 in the study group.In the control group,tuberculosis was confumed in only 8 cases by means of bacteriological examination in the BAL fluid,27 were confirmed by the following surgery ordiagnostic treatment of anti-Tuberculosis,and the other 5 cases were diagnosis as other diseases; In the study group,tuberculosis was confirmed in 28 patients through bacteriological and pathological examination,8 were false negative and the other 6 were diagnosis as non-tuberculosis diseases.The diagnostic sensitivity in the study group was significantly higher than that in control group (77.8％ verus 22.9％,x2 =21.4,P ＜ 0.01 ) ; and the negative predictive value in the EBUS-TBNA group was also significantly higher than that in the BAL group (42.9％ VS 15.6％,x2 =3.97,P =0.046).Complications were similar inthese 2 groups,only 1 case of intervention required puncture site bleeding happened in the study group.Conclusion EBUSTBNA has a higher sensitivity and negative predictive value in the diagnosis of smear and culture negative pulmorary tuberculosis patients with hilar or mediastinal lymph nodes.This technique is a safe method with few complications than the traditional BAL examination.It may play an important role in the diagnosis of smear and culture negative tuberculosis patients.

Objective:To investigate the joint associations of smoking and insufficient physical activity with hypertension, diabetes and dyslipidemia in male adults.Methods:Based on the data from the 2017 Nanjing Chronic Diseases Risk Factors Surveillance Program, 61 098 Nanjing residents aged 18 and older was randomly recruited from 12 districts, using the multi-stage stratified cluster sampling method. Information about smoking behaviors, physical activity and chronic disease-related indicators within the first 12 months before the survey was obtained through questionnaires.Results:Among the 29 848 valid male samples, the proportions of non-smokers, current smokers and ex-smokers were 59.6%, 37.2% and 3.2%, and the proportions of those who had physically active<600 MET-min/w (insufficient physically active) and ≥600 MET-min/w (adequate physically active) were 18.8% and 82.2%, respectively. In non-smokers, current smokers and ex-smokers, the prevalence of hypertension was 24.7%, 34.0% and 43.8%, and the prevalence of diabetes was 8.8%, 12.3% and 16.5%, and the prevalence of dyslipidemia was 26.8%, 36.1% and 41.9%, respectively. Multivariate logistic regression analysis showed that current smokers had a higher risk of hypertension ( OR=1.164, 95% CI: 1.086-1.248), diabetes ( OR=1.324, 95% CI: 1.207-1.452), and dyslipidemia ( OR=1.291, 95% CI: 1.216-1.371) than non-smokers in male adults. Compared with people who had adequate physical activity, someone with insufficient physical activity had higher hypertension ( OR=1.452, 95% CI: 1.331-1.583), diabetes ( OR=1.170, 95% CI: 1.041-1.315) and dyslipidemia ( OR=1.245, 95% CI: 1.158-1.338). And current smokers with insufficient physical activity had the highest risk of hypertension ( OR=1.749, 95% CI: 1.550-1.974), diabetes ( OR=1.363, 95% CI: 1.165-1.595), and dyslipidemia ( OR=1.614, 95% CI: 1.461-1.782) in male adults. Conclusions:Smoking and insufficient physical activity are risk factors for hypertension, diabetes, and dyslipidemia. People who is characterized by smoking together with insufficient physical activity presents with increased risk on developing hypertension, diabetes, and dyslipidemia.

BACKGROUNDTo explore the feasibility of cloning of the hepatocyte receptor interacting with the Pre S1 protein of HBV by two hybrid system.

METHODSYeast expression plasmids encoding fusion proteins of full length or portions of Pre S1 of HBV and DNA binding domain of yeast protein GAL4 were constructed and used to transform yeast reporter strain SFY526. Reporter gene product ?galactosidase activity was assayed as a measure of transcription activation in yeast. Mammalian expression plasmid encoding fusion proteins of full length Pre S1 and DNA binding domain of GAL4 was constructed and used to cotransfect hepatoma cell line Huh?7 together with CAT reporter plasmid. Cell extracts were assayed for CAT activity by thin?layer chromatography.

RESULTSThe fusion proteins of full length Pre S1 protein and GAL4 DNA binding domain present transcriptional activation function in yeast. The transcription activating sequence is localized to the 21 to 47 amino acids of Pre S1 protein Fusion proteins of full length Pre S 1 and GAL 4 DNA binding domain do not show transcriptional activation function in mammalian cells.

CONCLUSIONThe transcriptional activating sequence of HBVPre S1 protein in yeast overlaps the hepatocyte receptor binding site. The transcriptional activation function of HBV Pre S1 protein in yeast may prevent researchers?from using yeast two hybrid system to clone HBV receptor interacting with Pre S1 protein. However, the Pre S1 protein does not show transcriptional activation function in mammalian cells. Mammalian two?hybrid system may be a practical method to clone the HBV hepatocyte receptor interacting with Pre S1 protein.

DNA-Binding Proteins ; genetics ; Fungal Proteins ; genetics ; Hepatitis B Surface Antigens ; genetics ; Humans ; Protein Precursors ; genetics ; Recombinant Fusion Proteins ; genetics ; Transcriptional Activation ; Tumor Cells, Cultured ; Yeasts

Objective:To investigate the effect of biological long stem hemiarthroplasty on postoperative hip joint function, serum bone markers, angiotensin Ⅱ (Ang Ⅱ) and cortisol (Cor) levels in elderly patients with intertrochanteric fractures.Methods:A total of 120 elderly patients with intertrochanteric fractures in General Hospital of Northern Anhui Coal and Power Group from June 2017 to June 2019 were selected. According to the principle of non-randomized clinical concurrent controlled study and patient′s voluntariness, they were divided into arthroplasty group and internal fixation group, with 60 cases in each group. Proximal femoral nail antirotation (PFNA) was used in the internal fixation group, and the biological long stem hemiarthroplasty was performed in the arthroplasty group. The related indexes of perioperative operation and complications, the levels of serum AngⅡ and Cor before and after operation, the levels of serum bone markers osteocalcin (OC), calcitonin (CT), alkaline phosphatase (ALP) before and after operation were compared between the two groups. After followed up for 6 months after the operation, Harris hip function score and Barthel index (BI) score, quality of life score (GQOL-74) before and after operation, and the excellent and good rate of hip joint function at 6 months after operation were compared between the two groups.Results:The time of getting out of bed in the arthroplasty group was shorter than that in the internal fixation group, the operation time was longer than that in the internal fixation group, and the amount of blood loss and postoperative drainage were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The postoperative complication rate in the arthroplasty group was lower than that in the internal fixation group: 8.33%(5/60) vs. 25.00%(15/60), and the difference was statistically significant ( χ2 = 6.000, P<0.05). The levels of serum AngⅡ and Cor in the two groups were higher than those before the operation at the 1st and 3rd day after the operation, but the levels of serum AngⅡ and Cor in the arthroplasty group were also higher than those in the internal fixation group: at the 1st day after the operation: (218.68 ± 42.04) mmol/L vs. (158.19 ± 34.36) mmol/L, (327.15 ± 39.08) μg/L vs. (285.42 ± 34.06) μg/L; at the 3rd day after the operation: (169.46 ± 32.73) mmol/L vs. (138.02 ± 25.97) mmol/L, (294.83 ± 33.95) μg/L vs. (262.64 ± 30.57) μg/L, and the differences were statistically significant ( P<0.05). The levels of serum OC, CT, and ALP in the two groups at 1 month and 3 months after operation were higher than those before the operation, the levels of serum OC, CT, and ALP in the arthroplasty group were higher than those in the internal fixation group: at 1 month after operation: (17.40 ± 4.25) μg/L vs. (14.96 ± 3.79) μg/L, (1.34 ± 0.49) ng/L vs. (1.15 ± 0.43) ng/L, (159.49 ± 19.75) U/L vs. (137.24 ± 17.28) U/L; at 3 months after operation: (19.18 ± 5.79) μg/L vs. (16.24 ± 4.36) μg/L, (1.46 ± 0.57) ng/L vs. (1.24 ± 0.50) ng/L, (180.94 ± 22.42) U/L vs. (163.72 ± 19.36) U/L, and the differences were statistically significant ( P<0.05). TheHarris hip function scores at 1, 3 and 6 months after the operation in the two groups were higher than those before the operation, the Harris hip function scoresin the arthroplasty group were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The excellent and good rate of hip joint function at 6 months after operation in the arthroplasty group was higher than that in the internal fixation group: 90.00%(54/60) vs. 75.00%(45/60), and the difference was statistically significant ( χ2 = 4.675, P<0.05). The scores of BI, GQOL-74 at 1, 3, 6 months after operation in the two groups were higher than those before operation, the scores of BI, GQOL-74 at 1, 3, 6 months after operation in the arthroplasty group were higher than those in the internal fixation group, the differences were statistically significant ( P<0.05). Conclusions:Compared with PFNA internal fixation, the treatment of elderly patients with femoral intertrochanteric fracture with biological long stem hemiarthroplasty can promote the recovery of patients, reduce complications, reduce the impact on bone markers, and more effectively improve the patient′s hip joint function, ability of daily living and quality of life, but it is more traumatic to the body and has a strong stress response.

Objective To investigate the values of degree centrality (DC),a novel resting-state fMRI parameter,in voxel-wise whole-brain ftmctional networks analysis in patients with irritable bowel syndrome (IBS).Methods The resting-state functional MR imaging was performed in 21 IBS patients and 21 age-,education level-,and gender-matched normal healthy subjects,collected in our hospital from August 2013 to January 2015.DC map changes between the two patient groups were compared by two sample t test.Results As compared with the control group,patients with IBS showed significantly reduced DC values in right superior frontal gyrus,middle frontal gyrus,middle frontal gyrus of orbital part,middle temporal gyrus and precuneus.Conclusion Changes of DC value occurr in some regions of brain in the IBS patients;DC,as a novel resting-state functional MRI parameter in the voxel-wise whole-brain functional networks,might be an appealing altemative index for further studying on pathologic and neuropsychological states of IBS.

Objective: To analyze the characteristics of influenza virus detection in an influenza outbreak in schools, so as to provide a strategic basis for the treatment of influenza outbreaks in schools. Methods: A total of 1 702 samples were collected from 52 school influenza outbreaks reported in Linyi City in 2021-2022. The samples were divided into 3 types according to different symptoms during the management of the epidemic [group A:influenzalike illness (ILI) group; group B:mild illness group; group C:close contacts group]. Rt-PCR was used to detect influenza virus nucleic acid in the collected samples. The detection rate of influenza virus in the outbreaks was analyzed by χ2 test. Results: In total, 1 071 samples (62.93%) tested positive for influenza virus nucleic acid. Among them, 610 out of 726 samples (84.02%) were detected in group A, while 331 out of 634 samples (52.21%) were detected in group B. In group C, 130 out of 342 samples (38.01%) tested positive. The differences were statistically significant (χ2=260.71, P<0.01). In group A, males had a detection rate of 80.83% for influenza virus nucleic acid, compared to 91.36% for females. For group B, the rates were 53.31% for males and 50.87% for females. In group C, males had a rate of 30.72%, while females had a rate of 43.92%. Statistical significance for gender differences was observed only in groups A and C (χ2=12.67, 6.25, P<0.05). According to the days of onset, the detection rates of influenza virus nucleic acid among patients with onset 0-6 days were 56.30%, 74.49%, 89.35%, 86.23%, 69.67%, 62.75%, 34.33%, respectively, and the difference was statistically significant (χ2=128.27, P<0.01). Conclusions Mild cases and close contacts are likely key factors contributing to the prolonged emergence of new cases within classrooms during school influenza outbreaks. The progression of influenza symptoms is related to the risk of transmission.

In vitro diagnosis (IVD) is an important source of clinical diagnostic information, and provides an important decision basis for disease prevention, diagnosis and treatment. IVD is a necessary tool for promoting graded diagnosis and treatment, realizing precision medicine, constructing a "Healthy China" and responding to major public health emergencies. Combining the great progress made in the development of in vitro diagnostics in China and the shortcomings and weaknesses faced by it, this article analyzed the demand for IVD, policy support, technical and industrial development trends, and the ways to accelerate the industrialization development, aiming to promote the development and improvement of IVD in China.

Objective:To explore the association between different paths of diabetic progression and dyslipidemia in a Nanjing adult population.Methods:From January 2017 to June 2018, 61, 098 local residents aged ≥18 years were selected from the Chronic Disease and Risk Factor Surveillance database in Nanjing using a five-stage stratified cluster random sampling method. Data were collected through interview surveys, physical measurements, and laboratory examinations. The relationship between different rates of diabetic progression and dyslipidemia was analyzed using complex weighting and multilevel models.Results:In all, 60, 283 participants were finally enrolled in the study. The weighted proportions of normal glucose regulation, pre-diabetes, and diabetes were 71.2%, 17.9%, and 10.9%, respectively. The overall weighted prevalence, awareness, treatment, and control of dyslipidemia were 29.8%, 41.6%, 28.9%, and 22.9%, respectively. The weighted proportion of patients with dyslipidemia combined with diabetes was 52.9%. The weighted prevalence of dyslipidemia in adults with normal glucose regulation, pre-diabetes, and diabetes was 24.0%, 38.8%, and 52.9%, respectively (all P<0.001). Compared to the normal glucose regulation group, subjects with pre-diabetes ( OR = 2.04, 95% CI: 1.95-2.13) or diabetes ( OR= 3.87, 95% CI: 3.66-4.10) had possibly gradually increased risks of dyslipidemia (all P<0.001). In addition, there was an increasing trend toward awareness, treatment, and control of dyslipidemia with increasing levels of glucose (all P<0.001). The weighted awareness of dyslipidemia in adults with normal glucose regulation, pre-diabetes, and diabetes was 36.3%, 42.8%, and 56.2%, respectively; the corresponding rates of treatment and control were 23.7%, 29.2%, and 43.7%, and 20.4%, 22.6%, and 30.1%, respectively. Conclusion:Diabetes and dyslipidemia have become the main chronic diseases in the Nanjing population.

Objective: To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system. Methods: The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups. Results: Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms. Conclusions MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.