Objective To monitor the changes of T lymphocyte subsets during chemotherapy in patients with non-small cell lung cancer(NSCLC).Furthermore,to analyze the relationship between chemotherapy curative effect and the T lymphocyte subsets.Methods 42 cases with NSCLC were selected as the subjects,and 28 people undergoing health examination were selected as control group.All NSCLC patients just received NSCLC standard chemotherapy,then respectively determined T lymphocyte subsets at pre-chemotherapy and after 2,4 courses of chemotherapy.Every two cycles of chemotherapy we would evaluate the effect of chemotherapy.Results Before chemotherapy,the patients′ CD+3(t=3.222,P<0.01),CD+4 (t=9.655,P<0.01),CD+4/CD+8 (t=10.657,P<0.01) and NK lymphocytes (t=5.310,P<0.01) were significantly decreased than those of the control group,and CD+8 lymphocytes (t=7.926,P<0.01) increased significantly.There were no significant differences in patients' gender,age,but Ⅰ-Ⅱ period patients′ CD+4(t=2.097,P<0.05),CD+4/CD+8(t=2.045,P<0.05) immune function were better than Ⅲ-Ⅳ period patients.In patients with adenocarcinoma,CD+8(t=2.015,P<0.05),CD+4/CD+8(t=2.315,P<0.05) immune function were better than squamous carcinoma.The patients received chemotherapy after 2,4 courses,the T lymphocyte subgroup was comprehensively improved (P<0.01).The curative effect of chemotherapy was positively correlated with T lymphocyte function,PR>SD>PD.Conclusion Chemotherapy can improve the NSCLC patients′ T lymphocyte subgroup,and improve the situation related to the curative effect of chemotherapy.

Objective To discuss the related factors of the malignant tumor complicated with venous throm-boembolism(VTE),which may provide the clinical evidence for prevention,diagnosis and treatment of this disease. Methods Retrospectively reviewed the clinical data of patients with malignant tumor who were diagnosed with VTE from June 2012 to June 2015 in our hospital.Results Among 74 cases with tumor merger VTE,female with thrombosis was higher than the male.67.57% of the tumor with VTE patients was 45 -80 years old.Lung cancer patient with VTE was the highest almost 36.49%.Patients with deep vein catheterization,a history of surgery or merging of hyper-tension were easy occurred VTE,those were 14 cases (18.92%),12 cases (16.22%)and 11 cases (14.86%) respectively.57 VTE patients underwent radiotherapy or chemotherapy treatment.The platelet count,D -dimer, fibrinogen and CRP were associated with thrombosis.Among 74 cases with VTE,67 cases (90.54%)accepted anticoagulation therapy.Conclusion Sex,tumor disease,chemotherapy or radiotherapy treatment,medical history and coagluative function index were associated with VTE.Early diagnosis and treatment is the key to reduce mortality and improve prognosis of malignant tumor with VTE.

ObjectiveTo study the effects of small-dose glucocorticoid (GC) on glucocorticoid receptor (GR) and cellular immune function in critical patients.MethodsForty ICU critical patients admitted in Shanghai Changzheng Hospital from March 2007 to March 2009 were enrolled in the study and were divided into GC group and non-GC group according to the use or absence of GC.Blood samples were collected at days 1,7 and 10 after GC treatment to detect GR binding affinity of mononuclear leukocytes (MNLs) and polymorphonuclear leukocytes (PMLs) in the peripheral blood and the CD4/CD8 ratio in the T lymphocytes.The method of GC use was that the hydrocortisone was given intravenously at a dose of 100 mg every eight hours.ResultsGR binding capacity of MNLs at day 1 and 7 showed no statistical difference between the GC and non-GC groups.GR binding capacity of MNLs in the GC group was lower at day 1 and was much lower at day 7 (P ＜ 0.05 ).However,in the non-GC group,it was lower at day 1,but showed significant improvement at day 7 ( P ＜ 0.05 ).The change of GR binding capacity of PMLs was similar to that of MNLs.There was no significant difference of CD4/CD8 ratio between the GC and non-GC group at day 1.The ratio of CD4/CD8 in the non-GC group was significantly higher than that in the GC group at day 10 (P ＜0.05).CD4/CD8 ratio in the GC group showed a slight reduction at day 10,with no significant difference from that at day 1.While,the non-GC group showed a significant increase of CD4/CD8 ratio at day 10 as compared with that at day 1 (P ＜ 0.05 ).ConclusionLow-dose GC plays some role in the negative feedback regulation of GR binding capacity of peripheral blood leukocytes and in the inhibition of cellular immune function.

OBJECTIVE To explore the factors and effective preventive method of nosocomial lower respiratory(infection) after general anesthesia through trachea intubation.METHODS Using bacterial culture and identification technique to detect the samples collected from pipe and the sides of anesthetic machine,from disposable virus/(bacteri)a respiratory filter and buccal and bronchial secretion of patients with general anesthesia through trachea(intubation.) RESULTS Eight of 15 anesthetic machines without disinfection were with positive bacterial culture.All sides of virus/bacteria respiratory filter,and buccal and bronchial secretion of patients during operation had same(bacteria.) No bacteria growth was found in anesthetic machine and disposable virus/bacteria respiratory filter used after operation.The same bacteria as from buccal secretion were isolated from anesthetic machine in patients(without) using virus/bacteris respiratory filter.CONCLUSIONS The(results) showed the anesthetic machine is more easy to be contaminated by patients,and the reuse of anesthetic machine is an important factor for nosocomial(lower) respiratory infection after general anesthesia through trachea intubation.Intensifying periodic disinfection of(anesthetic) machine and using virus/bacteria respiratory filter can prevent contamination between anesthetic(machine) and patients and decrease nosocomial lower respiratory(infection) after operation.

Objective: To observe the influence of epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) on peripheral blood T lymphocyte subsets, and its efficacy and safety in the treatment of non-small cell lung cancer (NSCLC) patients.Methods: A total of 35 cases with NSCLC in our hospital were selected as the observation group and 28 healthy persons undergoing health examination at the same time were used as the control group.All the NSCLC patients were with EGFR mutations and accepted the EGFR-TKIs therapy.Flow cytometry was employed to detect T lymphocyte subsets in peripherial blood (including CD3+,CD4+,CD8+,CD4+/CD8+ and NK lymphocy-tes)in one week before the treatment, at the 1st, 2nd and 4th cycle after the EGFR-TKIs treatment, and the curative effect and safety were evaluated as well.Results: Before the chemotherapy, the levels of CD3+, CD4+, CD4+/CD8+ and NK lymphocytes in the NSCLC patients were significantly lower than those in the control group (P<0.01), and CD8+ lymphocytes increased significantly (P<0.01).After the treatment of 1, 2 and 4 cycles, the levels of CD4+and CD4+/CD8+ increased in varying degrees when compared with those before the treatment (P<0.01), and CD8+ decreased significantly when compared with that before the treatment (P<0.01).After the treatment of 2 and 4 cycles, NK cells increased in varying degrees when compared with those before the treatment (P<0.05).After the treatment of 4 cycles, the level of CD3+lymphocytes was significantly higher than that before the treatment (P<0.05).The T lymphocyte immune function in the patients with different therapeutic effects showed statistically significant difference (P<0.05).The order of lymphocyte subgroup improvement was PR>SD>PD.The adverse reactions caused by EGFR-TKIs were slight, and all could be improved markedly after the symptomatic treatment.Conclusion: EGFR-TKIs can significantly regulate the expression of T lymphocyte subsets in NSCLC patients and improve the immune function of the patients with promising safety.

Due to the particularity of the Intensive Care Unit(ICU)environment,the visiting time of family members is strictly limited,resulting in family members being unable to communicate with patients in time to understand their wishes and preferences.Moreover,the sudden onset of the diseases and clinical uncertainty can easily lead to ambivalence among family members in decision-making,leading to decision-making dilemmas.This paper reviewed the concepts,assessment tools,causes,effects,and coping strategies of decision-making dilemmas for family members of ICU patients,with a view to providing a theoretical basis for future intervention in decision-making dilemmas for family members of ICU patients,improving their quality of agency decision-making,shortening patient hospitalization time,improving the health outcomes of patients,and ultimately increasing the satisfaction of medical and nursing.

Objective To investigate the application value of p16/cell proliferation associated nuclear antigen (Ki-67) double-staining and human papillomavirus mRNA in the cytological screening.Methods Two hundred and fifty-one cases who suffered from atypical squamous cell of undetermined significance (ASCUS),low-grade squamous intraepithelial lesion (LSIL),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in ThinPrep cytologic test (TCT) were collected in Peking University First Hospital between October 2015 and March 2016.And p16/Ki-67 double-staining and hybrid capture Ⅱ (HC-Ⅱ) detection were performed on the cervical cells.The result was compared with the pathological result of colposcope guided biopsy.All statistical analysis was completed by Stata 12.0 statistical software analysis.The results of diagnostic tests were described by using the sensitivity,specificity,positive predictive value,negative predictive value,and the area under the receiver operating characteristic (ROC) curve.Results (1) One hundred and eight cases of liquid based cytology diagnosis of ASCUS patients,the positive rate of p16/Ki-67 was 13.9％ (15/108),102 cases of liquid based cytology diagnosis of LSIL patients,the positive rate of p16/Ki-67 was 21.6％ (22/102),41 cases of liquid based cytology diagnosis of ASC-H patients,the positive rate of p16/Ki-67 was 39.0％ (16/41),compared amongthree groups,the difference was statistically significant (x2=78.516,P＜0.05);cervical exfoliated cells p16/Ki-67 expression rate was 13.0％ (28/215) in cervical low-grade lesions [cervical intraepithelial neoplasia (CIN)Ⅰ],which was 69.4％ (25/36) in high level lesions (CIN Ⅱ-Ⅲ),the difference was statistically significant (x2=7.932,P＜0.05).(2) The specificity of p16/Ki-67 detection and diagnosis were higher than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (89.8％ vs 71.4％,83.3％ vs 15.6％,88.9％ vs 40.7％;all P＜0.05),meanwhile,the positive predictive value of p16/Ki-67 detection and diagnosis exceed those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (33.3％ vs 26.3％,31.8％ vs 12.6％,81.3％ vs 38.5％;all P＜0.05).Moreover,the ROC curve of p16/Ki-67 were bigger than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (0.799 vs 0.696,0.708 vs 0.531,0.909 vs 0.561;all P＜0.05).Conclusion For patients with cytological diagnosis of ASCUS,LSIL,and ASC-H,p16/Ki-67 double staining method could be used as an effective method to assist in the diagnosis of high-grade cervical lesions,and the screening efficiency is superior to that of high-rist HPV.

Objective To explore the difference of pharmacokinetic parameters derived from dynamic contrast enhanced (DCE) MRI between primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM).Methods Data of 17 patients with PCNSL and 21 patients with GBM were retrospectively analyzed.All patients underwent DCE MRI.The pharmacokinetic parameters (K,Kep,Ve) and the initial (60 s) area under the Gd concentration-time curve (iAUC) of peri-tumoral parenchymas (PT),enhancement tumors (ET) and contralateral normal parenchyma (NP) were obtained.The differences of various parameters were compared among different regions of PCNSL and GBM using one-way ANOVA.The differences of various parameters of PT,ET and NP were compared using independent samples t-test.Results There were statistical differences of K,Kep in ET,Kep in PT between PCNSL and GBM patients (all P＜0.05),as well as of K,Kep,Ve,iAUC in PCNSL and GBM patients between ET and PT (all P＜0.05).However,K and Kepof PT showed statistical differences compared with those of NP in GBM patients (both P＜0.05),so did Ktrans between PT and NP in PCSL patients (P＜0.05).Conclusion The pharmacokinetic parameters derived from DCE MRI based on extended Tofts Linear can promote differential diagnosis between PCNSL and GBM.

Forty-one patients with COVID-19 (22 males and 19 females with the age of 24~94 years) from February to March 2020 were enrolled in the study, including 15 severe or critically ill cases (severe group) and 26 moderate cases (non-severe group). The CT findings of intrapulmonary lesions at admission were evaluated and compared between severe and non-severe groups. There were significant difference between severe and non-severe groups in the aspects of the presence or absence of pure ground-glass opacity (GGO) (χ 2=10.791), GGO with focal consolidation (χ 2=5.512), sheet consolidation (χ 2=27.359), crazy paving sign (χ 2=8.343), thickening of the bronchial wall (χ 2=14.473), air bronchogram sign (χ 2=4.977), and pleural effusion (χ 2=6.561), all P<0.05. Multivariate logistic regression analysis showed that range of lesion involvement was a relevant factor for severe cases( OR=0.029,95 %CI:0.001-0.647, P=0.026). The study indicates that CT features are diverse in COVID-19 patients; there is lack of pure GGO, but more GGO with focal consolidation. The appearance of sheet consolidation and crazy paving sign and wide-range of lesion involvement and pleural effusion in CT findings may be indications for severe COVID-19.

Objective: To investigate the influence of pharmaceutical care pathway on cancer-related fatigue (CRF) and negative emotion in patients with advanced lung cancer undergoing chemotherapy. Methods: Patients with advanced lung cancer admitted to the oncology department of Yongkang first people′s hospital from January 2017 to June 2018 for chemotherapy were randomly divided into two groups:61 cases received conventional clinical pathway management (control group), and 64 cases received conventional clinical pathway combined with pharmaceutical pathway management (intervention group). Fatigue, anxiety, depression scores were compared between the two groups before and after 2, 4 cycles chemotherapy. Results: There was no significant difference in baseline condition between the two groups (P>0.05). After 4 cycles of chemotherapy, emotional, physical and cognitive fatigue scores in the intervention group were lower than control group (t=2.975, 1.512, 2.393, P<0.05). With the increase of chemotherapy cycles, scores of fatigue dimensions in control group were increased (F=44.274,21.740,29.261,7.206, P<0.05). In the intervention group, there were statistically significant differences in scores of fatigue dimensions (F=17.083, 15.902, 17.055, 10.543, P<0.01), among which, scores of behavioral and physical fatigue dimensions were increased (P<0.01), while scores of emotional and cognitive fatigue dimensions were decreased (P<0.01). In terms of negative emotions, depression scores in the intervention group were lower than those in control group at 2 cycles of chemotherapy (t=2.578, P<0.05), and at 4 cycles, anxiety and depression scores were lower than control group (t=7.004, 7.454, P<0.05). As the chemotherapy cycle increased, anxiety and depression scores in the control group increased (F=12.333, 14.819, P<0.05), while those in the intervention group decreased (F=4.992, 3.826, P<0.05). Conclusion The pathway of clinical pharmaceutical care can significantly improve the CRF and negative emotions of patients with advanced lung cancer undergoing chemotherapy.