As the public sanitation product of the government for the society,most of the public hospitals have the privilege of the free taxations and the finance subsidies.In theory,the hospitals have the duty to offer all the patients the timely and rational cure,especially the dying patients.In reality,some hospitals often appear some kinds of nonfeasance unfortunately when they face the dying patients because of the public policy and the private rule "ready money cure".The direct aftereffect is that the patient will get worse or even die.Consequently,it's necessary to confirm the characters and the components of the nonfeasance theoretically.Thus it's easy to distinguish the hospital duty and the patient right and also the legal relationship between them on further degree,and the liabilities in accordance.

This study was aimed to establish the quality standard of Pyrethri Tatsienenis Flos. The medical material was identified by the microscopy and the thin layer chromatography ( TLC ) methods . The moisture , total ash , acid-insoluble ash and alcohol-soluble extract were determined according to procedures recorded in the Chi-nese Pharmacopoeia (2010 edition). The content of luteolin was determined by the HPLC method. The results showed a strong characteristic microscopic of Pyrethri Tatsienenis Flos , and its TLC identification had a good resolution with clear spots . The mass fractions of luteolin was 0 . 036%~0 . 104% ( average of 0 . 078%) , moisture was 9 . 32%~15 . 82% ( average of 13 . 11%) , total ash was 6 . 65%~8 . 29% ( average of 7 . 45%) , acid-insoluble ash was 0 . 23%~0 . 59% ( average of 0 . 42%) , and the extraction was 21 . 42%~30 . 15% ( average of 24 . 86%) . It was concluded that this established standard was simple to operate with good stability and reproducibility , which can be used for quality evaluation of Pyrethri Tatsienenis Flos .

The article was aimed to study the influence of low pressure and hypoxia on rat metabolism and evaluate the intervention effect of San-Guo-Tang-San (SGTS) on high altitude polycythemia (HAPC) rats. A total of 25 rats were divided into the plain control group, high altitude model group, Hong-Jing-Tian capsule (Nuo-Di-Kang cap-sule) group, high-dose SGTS group and low-dose SGTS group, with 5 rats in each group. After one week adaptation, rats in the model group and the medication groups were put into the hyperbaric chamber for 40 days (22 h/d) to simulate high altitude environment of 5 000 m. In the end of 40th day, the hemorheology and the dry/wet weight ratio of lung of rats were measured. And plasma samples were derivatized with ECF prior to GC-MS instrumental analysis. Principal component analysis (PCA) was used to find potential biomarkers, and evaluate the intervention effects of SGTS. The results showed that the low pressure and hypoxia changed the hemorheology and dry/wet weight ratio of lung of rats markedly. Metabolomics studies showed that the high altitude model group, high-dose SGTS group, low-dose SGTS group, and Hong-Jing-Tian capsule group can be obviously differentiated. Main markers such as 9-hexylheptadecane, glycine, N-methyl-N-methoxycarbonyl-ethyl ester, 2,4-Di-tert-butylphenol, were found to be the endogenous substances of SGTS which intervening the HAPC rats. It was concluded that SGTS can intervene low pressure and hypoxia induced HAPC.

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology. Autoimmune thyroid diseases (AITD) is a type of autoimmune disease characterized by increased thyroid-specific antibodies. In recent years, more and more studies have found that the incidence of AITD is increased in OLP patients. The occurrence and development of OLP and AITD may be related to the expression of thyroid autoantigen in oral keratinocytes, the imbalance of thyroid hormone （Th）1/Th2 and Th17/Treg cell subsets, the abnormal quantity and function of follicular helper T cells and chemokines and the specific killing ability of CD8 T cells to target cells. In this article, the possible immune mechanisms involved in the coexistence of OLP and AITD are reviewed to provide insights for the diagnosis, treatment and prevention of these two diseases from the perspective of immunology.
Autoimmune Diseases/complications* ; Hashimoto Disease ; Humans ; Lichen Planus, Oral/complications* ; Mouth Mucosa ; Th17 Cells

Objective　To investigate the relationship of motor unit number estimation(MUNE)by multiple point stimulation with the outcome of surgical treatment patients with Hirayama disease(HD).Methods　A total of 36 consecutive patients including unilateral in 26 cases and bilateral in 10 cases with Hirayama disease treated by anterior cervical discectomy decompression and fusion in Peking University Third Hospital from October 2007 to May 2015 were reviewed retrospectively.There were 35 males and 1 female,aged from 16-26 years(average,19.2 years).A total of 46 hands were enrolled.Odom criteria was used to evaluate the subjective outcome of surgical treatment.Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digitiminimi preoperatively and at the time of pre-operation and the latest follow-up.Hands were divided into two groups based on Odom criteria(Group A with excellent and good;Group B with fair and poor).The difference between the two groups were examined by t text.Results　A total of 46 hands with complete clinical and electrophysiology data were followed up for 12-96 months(average,28.2 months).The outcome at the final follow-up according to Odom criteria was:Excellent in 8 cases,Good in 18 cases,Fair in 20 cases and no Poor case.MUNE of abductor pollicis brevis increased significantly after surgery from 139.6±68.4 to 188.2±60.4(t=-5.86,P<0.001).MUNE of abductor digitiminimi increased significantly after surgery from 75.0±66.3 to 104.2±80.4 significantly(t=-3.86,P<0.001).For two groups in age,follow-up period,preoperative MUNE of abductor pollicis brevis,and preoperative abductor digitiminimi,there was no significant difference.The illness course of Group A was 24.0±11.3 months,which was significantly shorter than Group B 34.9±21.2 months(t=-4.452,P<0.01).Group A had more increased MUNE of abductor pollicis brevis 65.6±64.1 compared with Group B 26.7±34.7(t=2.446,P<0.05)and Group A had more increased MUNE of abductor digitiminimi 42.6±59.3 compared with Group B 11.8±32.4 after surgery(t=2.088,P<0.05).Conclusion　MUNE by multiple point stimulating technique could be used to evaluate the neurological function of Hirayama disease and the outcome of surgical treatment quantitatively.

Objective:To explore the clinical application value of MRI in quantitative evaluation of anterior cruciate ligament mucoid degeneration (ACL-MD).Methods:From March to July 2020, 40 patients who were scheduled to undergo arthroscopic treatment were prospectively collected in the First Affiliated Hospital of Kunming Medical University.The anterior cruciate ligament tissue from the lateral edge of the tibial end was taken during the operation. Based on the pathologicalre sults, the patients were divided into the ACL-MD group ( n=19) and the normal group ( n=21). The sagittal plane three-dimensional steady-state rapid precession (3D-FIESTA), T 1 mapping, T 2 mapping, and T 2* mapping were performed before the knee joint surgery, and the scanned images were post-processed and analyzed to measure the T 1, T 2, and T 2* values of the tibial end of the anterior cruciate ligament.The relaxation time of the ACL-MD group and the normal group was compared using independent sample t test. The ROC curve was drawn using each parameter and the areas under the curve (AUC) for the diagnosis of ACL-MD were obtained.DeLong test was used to compare the differences of AUCs. Results:The T 1 [(1 291.9±273.4) ms], T 2 [(54.8±10.6) ms], and T 2* values [(30.6±6.4) ms] of anterior cruciate ligaments in the ACL-MD group were significantly higher than those in the normal group [ (1 087.0±121.0), (44.8±7.1), (20.4±4.8) ms; t=3.011, 3.473, 5.658, all P<0.001]. The AUCs of T 1, T 2, T 2* were 0.747, 0.764, 0.912, sensitivity of 63.2%, 63.2%, 100%, and the specificity of 100%, 95.2%, 76.2% in diagnosing ACL-MD. The AUC of the T 2* value was higher than those of the T 1 and T 2 values, and the differences were statistically significant ( Z=1.734, 2.162, P=0.043, 0.031). Conclusion:T 1, T 2, T 2*values measured by MRI quantitative imaging have high performance in assessing knee joint ACL-MD, and T 2* value has the largest AUC and the highest diagnostic efficiency.

OBJECTIVE To systematically evaluate the efficacy and safety of fondaparinux versus low molecular weight heparin（nadroparin，enoxaparin）in the treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS）. METHODS The computer searched PubMed ，Medline，Embase，EBSCO，CNKI，Wanfang medical network ，VIP Chinese Journal Full-text Database and relevant clinical trial registration network for the clinical retrospective cohort study （RCS）of fondaparinux （as trial group）and low molecular weight heparin （natroparin，enoxaparin）（as control group ）in the treatment of NSTE-ACS. The retrieval time limit was from the establishment of the database to August 2021. Newcastle Ottawa scale （NOS）was used to evaluate the quality of literature. Outcome indicators included primary efficacy indicators （incidence of acute myocardial infarction and recurrent angina pectoris during hospitalization ），secondary efficacy indicators [revascularization of target vessels during 话：0835-2862024。E-mail：xiexingxing07@163.com hospitalization， prothrombin time （PT）， activated partial thromboplastin time （APTT）]，safety indicators （incidence of serious cardiovascular events ，severe bleeding ，slight bleeding and severe puncture site co mplications during hospitalization ），combined endpoint indicators （30 and 180 days combined endpoint）. RevMan 5.3 software was used for Meta-analysis of each effect index. RESULTS Finally，17 RCS articles were included，involving 4 946 patients with NSTE-ACS ，including 2 507 in the trial group and 2 439 in the control group.The results of NOS literature quality evaluation showed that there were 8 high-quality studies ，accounting for 47.06％ . The results of Meta-analysis showed that there was no significant difference in the incidence of acute myocardial infarction ，recurrent angina pectoris，revascularization of target vessels ，PT and serious cardiovascular events between 2 groups （P＞0.05）；there was significant difference in the APTT （MD＝1.34，95％CI of 0.22-2.45，P＜0.05），the incidence of severe bleeding （RR＝0.47， 95％CI of 0.30-0.74，P＜0.05），the incidence of slight bleeding （RR＝0.48，95％CI of 0.32-0.71，P＜0.05），the incidence of severe puncture site complications （RR＝0.48，95％CI of 0.25-0.95，P＜0.05），30 day combined endpoint （RR＝0.57，95％CI of 0.46-0.72，P＜0.05），180 days combined endpoint （RR＝0.73，95％CI of 0.54-0.98，P＜0.05）. CONCLUSIONS Fondaparinux in the treatment of NSTE-ACS in China has the same efficacy as low molecular weight heparin （nadroparin，enoxaparin），and has more obvious advantages in drug safety such as bleeding ，severe puncture site complications.

Objective: To investigate the inhibitory effect of recombinant oncolytic adenovirusAd-Apoptin-hTERTp-E1A(ATV) on luciferase-labeled human lung cancer cells (A549-luc) and human lung cancerA549 cells, and to compare the differences in the inhibitory effect on two cell lines. Methods:ATV was used to infectA549-luc cells andA549 cells respectively. WST-1 and crystal violet staining were used to determine the difference in the inhibitory effect of ATV. Hoechst and Annexin V-FITC/PI staining were used to verify the inhibition mode ofATV. Results: WST-1 and crystal violet staining showed thatATV had significant inhibitory effect on bothA549-luc and A549 cells ( P <0.05). ATV showed significant inhibitory effect on both cells at 24, 48 and 72 h ( P <0.05 or P <0.01), and reached the peak at 72 h; ATV at concentrations of 1, 10 and 100 MOI all showed inhibitory effect on both cells, and reached the peak at 100 MOI. Hoechst staining showed that A549-luc cells and A549 cells infected with ATV showed typical nuclear fragmentation and marginal set. The results of Annexin V-FITC/PI Flow cytometry showed that ATV infection resulted in apoptosis of A549-luc and A549 cells, which was in a time-dependent manner and reached the peak at 72 h( P <0.05 or P <0.01). Conclusion: Insertion of luciferase didn’t significantly change the inhibitory effect and inhibitory mode ofATV onA549-luc cells.ATV exerted its in vitro inhibitory effect onA549-luc and A549 cells by inducing cell apoptosis.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.