Objective To evaluate the parametric features of image textures on 18F-FDG PET/CT for the differentiation between malignant and benign pulmonary nodules and compare the diagnostic performance of these parameters with SUVmax.Methods 18F-FDG PET/CT images of 170 patients (102 males,68 females,age range:29-81 (mean 59)years) with pulmonary nodules were retrospectively evaluated.Eightynine pulmonary nodules (230 slices) were malignant and 81 (193 slices) were benign.The pulmonary nodules were contoured on CT images and mapped to the co-registered PET images.Thirteen parameters of textural features were extracted and SUVmax was measured.Logistic regression analysis was used to identify the significant texture parameters and create a regression model.The efficacy of the textural features and SUVmax to distinguish between malignant and benign pulmonary nodules was evaluated by ROC curve analysis.The textural features of squamous cell carcinoma and adenocarcinoma were compared via the Mann-Whitney u test.The sensitivity and specificity of the textural features and SUVmax for the differential diagnosis were compared with x2 test.Results Logistic regression model identified 4 textural features (skewness (β =1.7058),kurtosis (β =-1.0989),angular second moment (ASM,3 =-4.4140) and strength (β =0.5626) ; all P ＜ 0.05) to have significant correlation with the malignancy of lung nodules.The AUC of ROC curve was 0.775 (95％ CI0.732-0.819; P＜0.001) with the sensitivity of 89.6％ (206/230) and specificity of 50.8％ (98/193).ASM and strength had statistically significant differences between squamous cell carcinoma and adenocarcinoma [ASM:0.0303 (95％ CI 0.0392-0.0724) vs 0.0594 (95％ CI 0.0721-0.0947) ; strength:2.4714 (95％ CI 2.4632-4.1050) vs 1.5945 (95％ CI 1.9003-2.4652) ; u =3082.0 and 3115.0,both P＜0.01].The AUC of SUVmax-based diagnosis was 0.757 (95％ CI 0.711-0.802 ; P ＜ 0.001) with the sensitivity of 80.9 ％ (186/230) and specificity of 50.3 ％ (97/193) at a cut-off value of 2.5.The sensitivity of the textural features was superior to SUVmax in differentiating malignant from benign pulmonary nodules (x2 =6.903,P ＜ 0.01).Conclusions Image textural parametric features extracted from 18 F-FDG PET/CT are more sensitive to differentiate between malignant and benign pulmonary nodules compared to SUVmax.They might also be useful to discriminate between different pathological types of lung cancers.

OBJECTIVE: To analyze the relationship between traditional Chinese medical syndromes and fungal pneumonia for moderate and advanced lung cancer patients. METHODS: We retrospected 115 moderate and advanced lung cancer patients with different syndromes in traditional Chinese medicine (qi deficiency, yin deficiency, blood deficiency, yang deficiency, blood stasis, phlegm dampness, phlegm heat, damp heat, cold dampness, qi stagnation, heat toxin), who had the concurrent fungal pneumonia, and used regression analysis method to analyze the data. RESULTS: When the patients had the phlegm heat syndrome, they got a significantly higher risk of having fungal pneumonia (P < 0.01); and when they had the heat toxin syndrome, they also had a high risk of having fungal pneumonia (P < 0.05). CONCLUSION: The phlegm heat and heat toxin syndromes are the risk factors for moderate and advanced lung cancer patients having concurrent fungal pneumonia.

Intensive care unit (ICU) in teaching hospital plays important roles in teaching work. The young teachers of critical care medicine are gradually becoming the backbone of teaching work. Improving the teaching ability of young teachers is essential to increase learning motivation of the students and to promote the overall teaching quality of critical care medicine. Therefore, pay attention to help the young teachers of critical care medicine to improve their teaching skill is good for enhancing the faculty developing of critical care medicine, as well as essential for the prosperity and sustainable development of critical care medicine. Based on the problems existing during the teaching process of young teachers of critical care medicine and aimed to train excellent teachers, this article discussed the teaching methods and experience of young teachers of critical care medicine which focuses on teaching program design, class affinity improvement and humanistic education in order to improve the teaching level of young teachers of critical care medicine.

Objective:To investigate the effect of salvianolic acid C (SalC) on fibroblast-like synoviocytes and through the role of nuclear factor-erythroid 2-related factor 2 (Nrf2) pathway.Methods:Rheumatoid arthritis-fibroblast-like synoviocytes (RA-FLSs) were exposed to different concentrations of SalC (0.1 μmol/L, 1 μmol/L, 5 μmol/L, 10 μmol/L, 20 μmol/L) for 24-72 h and measured for viability, proliferation, migration and invasion by Cell counting kit 8 (CCK-8) assay, wound-healing and transwell assay. The levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-1 beta (IL-1β) and IL-6 were measured by enzyme linked immunosorbent assay (ELISA). Western blot was used to detect the expression of matrix metallopeptidase (MMP)-9, MMP-13, apoptosis-related proteins and Nrf2 mediated gene. Then we used ML385 to inhibit Nrf2 signaling pathway. RA-FLSs were measured for migration and invasion, and the expression of proteins related to apoptosis, inflammation and Nrf2 pathway.Results:Compared with the control group, SalC inhibited the cell migration significantly (0.1 μmol/L, 0.75±0.05, t=7.65, P<0.001; 5 μmol/L, 0.50±0.05, t=14.25, P<0.001; 10 μmol/L, 0.26±0.05, t=20.67, P<0.001) and invasion (0.1 μmol/L, 0.75±0.11, t=4.93, P<0.001; 5 μmol/L, 0.49±0.06, t=10.32, P<0.001; 10 μmol/L, 0.26±0.07 , t=14.96, P<0.001) of RA-FLs, reduced the levels of MMP-9 (0.1 μmol/L, 0.72±0.10, t=5.60, P<0.001; 5 μmol/L, 0.48±0.08, t=11.03, P<0.001; 10 μmol/L, 0.27±0.06, t=15.94, P<0.001) and MMP-13 (0.1 μmol/L, 0.77±0.06, t=8.66, P<0.001; 5 μmol/L, 0.58±0.06, t=11.03, P<0.001; 10 μmol/L, 0.32±0.13, t=14.22, P<0.001), and promoted apoptosis. SalC reduced the level of pro-inflammatory cytokines significantly ( P<0.001) and activated the expression of Nrf2 signaling pathway proteins Nrf2, CAT, NQO1, SOD1 and GSS ( P<0.001). After ML385 was used to interfere Nrf2, the levels of SalC on Nrf2 pathway proteins, such as Nrf2 (0.68±0.06, t=5.08, P<0.001), CAT (1.44±0.12, t=4.77, P<0.001), NQO1 (0.65±0.12, t=5.04, P<0.001), SOD1 (1.43±0.10, t=6.36, P<0.001) and GSS (1.42±0.10, t=7.60, P<0.001), as well as the levels of TNF-α [(260±22) pg/ml, t=13.75, P<0.001], IL-1β [(701±30) pg/ml, t=12.98, P<0.001], IL-6 [(180±10) pg/ml, t=16.38, P<0.001) were significantly reduced. In addition, ML385 inhibited the inhibition of SalC on cell migration and invasion (0.70±0.09, t=11.24, P<0.001; 0.64±0.04, t=8.03, P<0.001) and induction of apoptosis (24.4±1.8, t=23.02, P<0.001). Conclusion:SalC may inhibit cell activity and inflammatory response, promote apoptosis via the upregulation of Nrf2 signaling pathway. SalC may have therapeutic potential in RA. However, further investigation are needed in animal models and human.