Objective To better understand the relationship between the maximum tumor diameter and the most distant micrometastases in different types of non-small cell lung cancer (NSCLC) and to provide histological evidence for the delineation of clinical target volume (CTV) from gross tumor volume.Methods We retrospectively studied the pathological specimens from 113 surgically treated NSCLC patients (44 squamous cell carcinoma patients and 69 adenocarcinoma patients) who were admitted to our hospital from 2014 to 2015.The maximum tumor diameter was determined by a combination of gross and microscopic measurements.Micrometastases were microscopically determined.The distances between the tumor edges and micrometastases outside the tumor boundaries were measured by an ocular micrometer followed by a calculation.Quantitative data were analyzed by t test, and qualitative data were analyzed by logistic regression.Results The regression relationship between the maximum tumor diameter and micrometastases was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.151).The association between the presence or absence of lymph node metastasis and the most distant micrometastasis was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.597).No association between the degree of tumor differentiation and the most distant micrometastasis was observed in either group (P=0.113).The average measurement of the most distant micrometastases was 2.94 mm in the adenocarcinoma group, with 7.5 mm as the distance to cover 95% of the most distant micrometastases.To reach the same coverage, 4 mm was needed for tumor size smaller than 3 cm, 6 mm for those between 3 cm and 5 cm, and 7.5 mm for those larger than 5 cm.The average measurement of the most distant micrometastases was 2.69 mm in the squamous cell carcinoma group, with 6 mm as the distance to cover 95% of the most distant micrometastases.Conclusions For NSCLC, the most distant micrometastasis of adenocarcinoma is associated with the maximum tumor diameter and presence or absence of lymph node metastasis, and the CTV should thus be adjusted accordingly;no relevance between the most distant micrometastasis and maximum tumor diameter is observed in squamous cell carcinoma;there is no relationship between the most distant micrometastasis and the degree of tumor differentiation in adenocarcinoma and squamous cell carcinoma.

Objective To establish an evaluation index system of electricity saving at general hospitals.Methods Based on civil building energy saving studies and in accordance with national regulations on hospital energy saving, the authors build an electricity saving index system for general hospitals.The indexes were reduced by the rough set theory, and their weight was determined by analytical hierarchy process and expert analysis.Results An electricity saving evaluation index system for general hospitals is so developed, consisting of six level-2 indexes and 27 level-3 indexes.Conclusions Such an evaluation index system can guide hospital electricity consumption and saving.

Objective To discuss the expression level of serum procalcitonin( PCT) and clinical val-ue in acute viral diarrhea patients. Methods A total of 186 patients with acute viral diarrhea treated in our hospital from September 2013 to September 2015 were retrospectively reviewed. One hundred and seven were male and 79 were female,of which 171 cases were infected by rotavirus and 15 cases infected by norovirus. The average age was ( 1. 29 ± 0. 89 ) years old. All patients′ blood and stool cultures were negative. The patients were divided into three groups according to the degree of dehydration and whether complicated with multiple organ dysfunction or not:severe group( complicated with severe dehydration,shock or multiple organ dysfunction,n=33),mild-moderate dehydration group(n=68) and no dehydration group(n=85). Thirty-five healthy children with the same age were enrolled as the control group. Serum PCT levels,high sensitivity CRP(hs CRP) and blood routine were detected. Results The serum PCT levels increased in 73 patients with acute viral diarrhea,8 cases>100 ng/ml,21 cases 5 to 100 ng/ml and 44 cases 0. 5 to 5. 0 ng/ml. PCT( ng/ml)[0. 36(0. 14,1. 67),hsCRP(mg/L)[3. 50(0. 70,14. 83)] and WBC( × 109/L)[9. 06(6. 79,12. 50)] levels increased in the diarrhea patients compared with those in the healthy group[0. 09(0. 05,0. 13);1. 00 (0.40,2.50);6.90(5.90,8.20)](all P < 0.05). The level of PCT in patients with dehydration [0.54 (0. 19,7. 83)]was higher than that without dehydration[ 0. 26(0. 11,0. 55)](P<0. 05) and increased in severe group[13. 69(3. 41,60. 30)] compared with in those the mild-moderate group[0. 33(0. 13,0. 89)] and no dehydration group[0. 26(0. 11,0. 55)](all P<0. 017),but there was no difference among groups in hsCRP and WBC levels ( P>0. 05 ) . Conclusion PCT can increase in pediatric patients with acute viral diarrhea,especially in those with severe dehydration,shock and organ dysfunction. Continued high levels of PCT indicates critical condition and has poor prognosis. PCT can be used as a good indicator to evaluate the severity of disease and the prognosis.

OBJECTIVETo investigate the relationship between the variation of chloroplast DNA gene sequences and the geographical origins of Polygonum capitatum in order to provide the molecular evidence for its excellent germplasm resources.

METHODPCR direct sequencing was applied to detect the chloroplast psbA-trnH, trnL-trnF gene sequence of 11 samples collected from 11 populations of P. capitatum.

RESULTThe psbA-trnH gene sequence of P. capitatum from different populations was 402 bp in length, there were 6 variable sites. TrnL-F gene sequence was 875 bp, there were 5 variable sites. The clusters diagram by UPGMA method showed that P. capitatum groups in Yunnan and Guizhou existed a considerable variation.

CONCLUSIONP. capitaturni which is located in the east of Yunnan and the west of Guizhou is helpful of screening the germplasm resources.

Alleles ; Base Sequence ; DNA, Chloroplast ; genetics ; Molecular Sequence Data ; Mutation ; Phylogeny ; Polygonum ; classification ; genetics ; Sequence Alignment ; Sequence Analysis, DNA

OBJECTIVEThrough comparative study on contents of icariin and total flavonoid of Epimedium acuminatum in different habitats and parts, the distribution and correlation of the two components were observed.

METHODTwenty-four sample spots in four habitats were set up, and the whole plant of these samples was divided as following: leaf, root, stem and rhizome. Total flavonoid and icariin of samples were determined by using the UV method and the HPLC, respectively. The data was analyzed by SPSS 17.0.

RESULTThe distribution of icariin in different parts had the pattern: leaf > root > stem > rhizome, the total flavonoid content was higher in leaf, but it showed no difference in other parts. Habitat had certain effect on icariin accumulation in E. acuminatum. The significant differences of total flavonoid content in E. acuminatum from different parts were not observed.

CONCLUSIONThe distribution of icariin from different parts and habitats has high selectivity. Metabolism and accumulation of flavonoid content in each part have no difference. Flavonoid content is less affected by environment. Considering the distribution of icariin and flavonoid content in every part and the growth strategy in different habitats comprehensively, it is reasonable to harvest the aerial part for the sustainable utilization of E. acuminatum.

Drugs, Chinese Herbal ; chemistry ; metabolism ; Ecosystem ; Epimedium ; chemistry ; metabolism ; Flavonoids ; analysis ; metabolism ; Plant Structures ; chemistry ; metabolism

Objective:To explore the clinical features of decompensated liver cirrhosis patients with acute kidney injury (AKI) progressing to chronic kidney disease (CKD) and its impact on prognosis.Methods:From January 2015 to July 2019, at Tianjin Second People′s Hospital, the general data and laboratory test results of 346 hospitalized patients with decompensated liver cirrhosis were retrospectively analyzed. The patients were followed up for 12 months. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of AKI and CKD. Kaplan-Meier method was used for survival analysis. The independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:A total of 128 patients with decompensated liver cirrhosis developed AKI, and 25 of them developed into CKD. Univariate analysis showed that age, hypertension, complications of liver cirrhosis infection, ascites and hepatic encephalopathy, acute-on-chronic liver failure, Child-Turcotte-Pugh score of liver function, baseline serum creatinine, post-admission serum creatinine, serum sodium, white blood cell count, total cholesterol, triglyceride, high-density lipoprotein, total bilirubin, albumin, international normalized ratio (INR) and prothrombin time activity were risk factors of AKI in patients with decompensated liver cirrhosis ( t=3.822, χ2=12.534, 26.761, 5.035, 3.894 and 26.101, U=7 004.500, 9 132.500, 5 925.000, 10 144.000, 10 717.500, 10 827.000, 10 912.000, 5 741.500, 10 017.000, 10 187.500, 11 680.500 and 11 321.500, all P<0.05). The risk factors of AKI progressing to CKD in decompensated liver cirrhosis included the etiology of liver cirrhosis, hypertension, baseline serum creatinine, serum creatinine at the time of diagnosis of AKI, total cholesterol, INR, AKI etiology and AKI classification ( χ2=13.153 and 9.144, U=353.000, 337.000, 576.500 and 481.000, χ2=9.501 and 17.801, all P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors of AKI progressing to CKD in decompensated liver cirrhosis included baseline serum creatinine (odds ratio ( OR)=1.066, 95% confidence interval ( CI) 1.020 to 1.114, P=0.005) and AKI classification ( OR=6.086, 95% CI 1.828 to 20.260, P=0.003). The Kaplan-Meier survival curve showing that after following up for 12 months, the survival rate of patients with decompensated liver cirrhosis patients who progressed to CKD from AKI was lower than that of patients who did not developed into CKD (52.0%, 13/25 vs. 86.4%, 51/59), and the difference was statistically significant ( χ2=11.482, P=0.001). Conclusion:The transition from AKI into CKD is common in patients with liver cirrhosis, which affects the clinical prognosis and reduces the survival rate.

Objective To discuss the influence of exogenous Gibberellin (GA3) and abscisic acid (ABA) on genetic expressions of key enzymes in ethylene synthesis in Taizishen (Pseudostillaria Root, Radix Pseudostellariae) , and provide reference for intelligent use of growth regulators during cultivation of Taizishen.Methods The genes of key enzymes in ethylene synthesis of Taizishen were screened and identified from transcriptome database by using local Blast method.Hai'ershen in full-bloom stage was treated with exogenous GA3 and ABA, and samples were collected at different time points (20 d, 40 d, 50 d and 60 d.The genetic expressions of key enzymes in ethylene synthesis of Taizishen were detected by using real-time fluorescence polymerase chain reaction (RT-PCR).Results There were totally 6 genes of key enzymes in ethylene synthesis in roots of Taizishen obtained, and they were named PhACO1, PhACO2, PhACO3, PhACS1, PhACS2 and PhSAMS.GA3 and ABA could regulated the expressions of above 6 genes, and expressions of PhACO1, PhACO2, PhACS1 and PhSAMS were up-regulated after treated with GA3, and expressions of PhACO3 and PhACS2 were up-regulated after 20 d to 40 d and down-regulated after 50 d to 60 d.The expressions of genes of key enzymes in ethylene synthesis in Taizishen showed down-regulation at first and then up-regulation after treated with ABA, but different genes had different demonstrations.The expression of PhACO1 was up-regulated after 20 d to 60 d, and down-regulated after 40 d to 50 d.The expressions of PhACO2 and PhACO3 were down-regulated after 20 d to 50 d, and up-regulated after 60 d.The expression of PhACS1 was down-regulated after 20, up-regulated after 40 d to 60 d.The expressions of PhACS2 and PhSAMS were down-regulated.Conclusion GA3 and ABA may control the ethylene signaling pathway to regulate plant growth through affecting the ethylene biosynthesis of Taizishen.It is speculated that Taizishen is treated with suitable concentration of GA3 in adventitious root growth period and treated with ABA treatment in root thickening period, the yield of Taizishen will be increased.

This paper summarized the research progress of traditional Chinese medicine(TCM) constitutional types and related factors in the elderly. It sumed up the distribution characteristics of the elderly constitutional types and the correlation between constitution and the disease. This paper helped to improve the health of the elderly, to prevent and control of chronic disease sooner, and to show the TCM advantages of "abidance by triple pathogens".

Objective:This study compares the magnetic resonance imaging (MRI) appearance of two types of breast tissue markers to investigate the appropriate clinical application of the markers.Methods:Breast MRI of 69 patients (78 masses) with breast tissue markers had been placed were analyzed retrospectively from November 2015 to August 2018 in our hospital. The sizes and shapes of breast tissue markers were assessed in axial fat-suppressed T2-weighted images, T1-weighted images and contrast-enhanced T1-weighed images.Results:The length of the coil nickel-free stainless steel markers were greater than ribbon titanium markers, with statistical difference in fat-suppressed T2-weighted images ( P=0.039). In contrast-enhanced T1-weighted images, all coil nickel-free stainless steel markers showed >6 mm diameter and round shape, and ribbon titanium markers showed >6 mm diameter ( n=20) or ≤6 mm diameter ( n=8), and round ( n=20), dot ( n=7) or band ( n=1) shapes. The categories of sizes and shapes in two types of breast tissue markers both had statistical significance ( P<0.001, P<0.001). Conclusions:Small breast lesions with breast tissue markers are not suitable for MRI evaluation. The artifact of ribbon titanium markers is smaller than coil nickel-free stainless steel markers, so they have less impact for lesions. The choice of the breast tissue markers and image evaluation methods should depend on the different clinical conditions.

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.