ObjectiveTo investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous veno-venous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.Results The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9±7.3)% vs. (26.4±6.7)%,P>0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9±8.6)% vs. (29.3±7.1)%, 5 days: (42.7±9.2)%vs. (31.4±6.5)%, 7 days: (40.9±8.5)% vs. (29.4±6.7)%, allP< 0.05]. There was no significant difference in APACHEⅡ score before treatment between experimental group and control group (22.4±5.3 vs. 21.7±6.2,P>0.05). APACHEⅡ score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6±3.6 vs. 20.5±4.3, 5 days: 15.8±3.9 vs. 21.1±4.4, 7 days: 14.9±4.2 vs. 19.8±3.7, allP< 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3±3.4 vs. 19.8±3.7,t = 6.432,P = 0.003) and length of ICU stay (days: 20.7±3.9 vs. 26.8±4.7,t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%,χ2 = 3.121,P = 0.016).Conclusion Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.

Objective To evaluate whether an early change in 18F-fluorodeoxyglucose (18F-FDG) uptake can predict tumor response to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and prognosis in patients with non-small cell lung cancer (NSCLC). Methods From August 2009 to April 2015, 22 patients with NSCLC who were eligible to EGFR-TKI treatment were enrolled. PET-CT scan was performed before (baseline) and 1 month after EGFR-TKI administration. Up to 5 hottest single tumor lesions (no more than 2 per organ) were considered to be target lesions. Maximum standardized uptake values (SUVmax) were measured, and post-treatment percentage changes in SUVmax (ΔSUV%) were calculated. PET responses were classified using PET response criteria in solid tumors (PERCIST). Then conventional CT scan was performed every 2 months for follow-up. Kappa statistic was used to compare agreement between the RERCIST recommendations-based therapeutic response evaluation and those based on RECIST1.1 criteria. Fisher exact test was used to compare the probability of disease progression in the early metabolic response and non-response groups. Predictive accuracy of ΔSUV% with respect to response or non-progression at CT scan was evaluated by ROC analysis. Progression-free survival (PFS) was determined by Kaplan-Meier survival analysis, and between-group comparison was performed by log-rank test. Results After 1 month of EGFR-TKI treatment, 12 patients (55%) showed partial metabolic response (PMR), 6 (27%) had stable metabolic disease (SMD), and 4 (18%) had progressive metabolic disease (PMD). There was a moderate agreement(Kappa=0.506,P<0.05) between PET response at 1 month based on PERCIST recommendations and CT response at 3 months according to RECIST 1.1. Non-progression was significantly more frequent in patients with an early PMR (χ2=11.941, P=0.005). Progression had been confirmed later during therapy in all patients with PMD . By using ROC analysis, the area under the curve for prediction of response was 0.906 (95% CI, 0.766—1.000; P=0.002), corresponding to a sensitivity of 88.9% and specificity of 84.6% at a cut-off of 40.36% in ΔSUV%. Using a cut-off value of 25.84% in ΔSUV%, highΔSUV% group (ΔSUV% ≥ 25.84%) had significantly longer PFS than low ΔSUV% group (ΔSUV%<25.84%). Conclusion Early assessment of PET-CT at 1 month of EGFR-TKI treatment could be useful to predict tumor response and clinical outcome in patients with NSCLC.

Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

Objective To explore the timing of local anesthesia in ultrasound-guided modified Seldinger technique PICC puncture, so as to provide theoretical basis for formulating unified operating standards in clinic. Methods Totals of 128 patients with PICC after operation were randomly divided into pre-anesthesia group and post-anesthesia group (64 cases in each group).In pre-anesthesia group, 0.2 ml 2%lidocaine was injected in the puncture point before puncturing; in post-anesthesia group, 0.2 ml 2% lidocaine was injected after puncturing.Body pain score in the process of puncturing and times of puncturing were compared between the two groups.Results The body pain score in pre-anesthesia group was (1.64 ±1.58),and (1.64 ±1.21)in post-anesthesia group, the difference was not statistically significant (t=0.00,P>0.05).The times of puncturing in pre-anesthesia group was (1.59 ±1.35), which higher than (1.18 ±0.50) in post-anesthesia group, and the difference was statistically significant (t=2.20,P<0.05).In pre-anesthesia group, the distance from local anesthesia point to the actual piercing point was positively related to pain score (r =0.319,P <0.05). Conclusions The pain were no different caused by local anesthesia before and after piercing, but less piercing times in condition of anesthesia after putting thread in, which can improve the success rate of puncture.

Objective To have a better understanding of the effort-reward imbalance for learning and learning burnout of high school students and their relationship. Methods A sample of 420 high school students was selected by stratified random sampling. Scales were used to study the effort-reward imbalance for learning and learning burnout and multiple linear regression analysis was used to study their relationship. Results A total of 387 high school students were actually investigated and 42.38% of which had effort-reward imbalance for learning. There were no significant differences in the rates of effort-reward imbalance for learning between students of different grades and between students of different homeplaces (P>0.05) . Female students had higher level of excessive input than males (P<0.05) . The average score of learning burnout was 56.93±13.22. There were no statistically significant differences in the scores of learning burnout between students of different genders and between students of different homeplaces (P>0.05) . The students who had effort-reward imbalance for learning scored higher in learning burnout than that who did not (P<0.05) . Senior Three students scored higher in learning burnout than Senior Two and One students (P<0.05) . The multiple linear regression analysis showed that learning reward and excessive input was both negatively correlated with learning burnout (all P<0.05) . Conclusion The high school students in Lishui City generally had the effort-reward imbalance for learning and learning burnout. learning reward and excessive input have effects on learning burnout.

Objective:To analyze the long-term efficacy and safety of re-irradiation for recurrent glioma.Methods:The data of 52 patients with recurrent gliomas were collected from 2009 to 2019. The median planned targetvolume (PTV) was 73.5 cm 3(49.9-102.7 cm 3) and the median dose was 45.0 Gy (43.0-48.8 Gy). Kaplan-Meier method was used for survival assessment, log-rank test for difference assessment, and Cox’s regression model for multivariate prognostic analysis. Results:The median follow-up time was 32.6 months. The median overall survival (OS) and progression-free survival (PFS) time were 16.1 months (95% CI, 4.1-28.1) and 8.0 months (95% CI, 4.0-12.0). The 1-, 2-and 3-year survival rates were 67%, 43% and 29%, respectively. The 6-month, 1-year and 2-year PFS rates were 67%, 40%, 26%, respectively. Multivariate analysis showed that KPS score and recurrence time significantly affected the OS ( P=0.012, P=0.001). KPS score and time interval between two radiotherapies significantly impacted the PFS ( P=0.003, P=0.018). Stratified analysis showed that KPS score was the independent prognostic factor of OS and PFS in patients with WHO grade Ⅱ initial pathology and reoperation after recurrence ( P<0.001, P=0.012); clinical manifestation was the independent prognostic factor of OS and PFS in patients with WHO grade Ⅲ and Ⅳ initial pathology ( P=0.006, P=0.044). The overall incidence of adverse reactions was 30.8%. Grade 1 adverse reactions accounted for 25.0%, and 5.8% for grade 2. Conclusions:Re-irradiation for recurrent glioma yields good long-term clinical efficacy and tolerable adverse reactions.

Objective: To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management. Methods: From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36⁺⁶ weeks) and equal number of full-term primiparae (full-term group, 37 to 41⁺⁶ weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test. Results: The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=-5.835; (29.9±16.8) vs (34.2±17.2) min, t=-12.637; both P<0.001] and the active phase [M (P₉₅): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P₅): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=-2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%),109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively. Conclusions Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.

Objective: To analyse the genomic characteristics of Novirus(NoV) GII.4 genotype JN010 strain isolated form Jinan in 2017. Methods: Seven pairs of primers were designed and used to amplify the JN010 genome. Sequence analyses, alignment and phylogenetic trees of ORF1 and ORF2 genes were performed using the software Lasergene7.1 and MEGA5.2. At the same time the major protein VP1 amino acid mutations were analyzed. Results: The 7 516 bp complete genome sequence of JN010 strain was obtained, the most mutation sites were located in P2 subdomain of VP1. Two substitutions I293N and H373N of VP1 were locate neighboring epitope A, and R297H mutation happened within epitope A and the site A that binding with histo-blood group antigens(HBGAs). The JN010 strain was GII.Pe/GII.4 genotype and genetically closest to the strains found in Osaka of Japan(GenBank accession number LC066046) and the strains in Zhongshan city of Guangdong (GenBank accession number KY407064) respectively according to ORF1 and ORF2 gene homologous and phylogenetic analysis. Conclusions The NoV GII.4 variant strain JN010 has occurred mutations in the key site of the epitope A and site A that bind with HBGAs, and maybe affect its antigenicity and interaction with HBGAs.

Objective To evaluate the methods in early warning of schistosomiasis and elimination of snails in an ecological public forest in Yexie Town of Songjiang District, and provide the basis for monitoring and controlling snails in forest land in the future. Methods The monitoring data of snails, schistosomiasis and snail elimination in the public forest were collected to evaluate the effect of controlling snails. Results The area with existence of snails was found to be 10.47 hm², and it was decreased by 98.28% after three times of snail elimination.A total of 1 904 serological tests was performed (test rate of 88.76%) with the positive rate of 0.16%.Pathogenic test result was negative in 3 subjects examined.Serological samples of 11 dogs and 1 sheep were all negative for the test.None of the 1 480 live snails tested was found to be positive in infection.The awareness rate of schistosomiasis control knowledge and behavior formation in 275 students were 98.2% and 95.3%, respectively. Conclusion The snails in the public forest in Yexie Town have been effectively controlled, but there are still scattered living snails.The measures in eliminating and monitoring of snails should be continued and strengthened.