Objective To investigate the formation mechanism of string beads sign in peripheral small cell lung cancer (SCLC) and evaluate the significance of it in differential diagnosis among SCLC,peripheral lung adenocarcinoma and peripheral lung squa-mous cell carcinoma.Methods 78 cases of SCLC,69 cases of peripheral lung adenocarcinoma and 33 cases of peripheral lung squa-mous cell carcinoma,confirmed pathologically were included in this study.The positive rates of string beads sign,mediastinal lymph node metastasis and mediastinal lymph nodes larger than primary lung lesions were calculated and analyzed in these three groups.Results 10 out of SCLC cases (12.8%)have string beads sign,in which all mediastinal lymph nodes were larger than lung lesions.Mediasti-nal lymph node metastases were observed in 63(80.8%)of 78 cases,and 42 (53.8%)cases had larger mediastinal lymph nodes than lung lesions.No string beads sign was observed in patients with peripheral solid lung adenocarcinomas,but 25 of 69 cases (36.2%) have mediastinal lymph node metastasis and 2 cases (2.9%)had larger mediastinal lymph nodes than lung lesions.13 cases(39.4%) of 33 patients with peripheral lung squamous cell carcinomas had mediastinal lymph node metastasis,and 6 cases (16.7%)had larger mediastinal lymph nodes than lung lesions.The statistical results showed the positive rate of string beads sign was not significantly different between peripheral SCLC group and peripheral lung squamous cell carcinoma group,but that of mediastinal lymph node and larger mediastinal lymph nodes than lung lesions were statistically different among these three groups.Conclusion To some extent, string beads sign on CT could reflect the biologic character of SCLC.It played an important role in differential diagnosis of peripheral SCLC,peripheral lung adenocarcinoma and periph-eral lung squamous cell carcinoma,but it should be combined with mediastinal lymph node size.

Objective To investigate the risk factors for coronary artery lesions (CALs) in children with Kawasaki disease (KD) in Lanzhou. Methods One hundred and seventy-four children with diagnosed KD were divided into CAL group and non-CAL group based on the existence of concurrent CALs. The age, gender, fever duration, intravenous immunoglobulin (IVIG) start time, IVIG dose, C-reactive protein (CRP), serum albumin, erythrocyte sedimentation rate (ESR), platelet (PLT), red blood cell count (RBC), hemoglobin and so on were compared. Results Among the 174 children, 46 children (26.44%) were complicated by CALs and 128 children were not. The differences of average fever duration, IVIG starting time, IVIG dose, PLT, CRP, ESR and RBC were statistically signiifcant (P<0.05). Conclusions When KD children has the fever durations>10 d, start of IVIG af-ter 10 days of fever, increase of PLT, CRP and ESR and decrease of RBC, clinicians should be alert to the risk of concurrent CAL.

Objective:To compare the clinical characteristics and prognosis of children with necrotizing pneumonia (NP) infected by bacteria and Mycoplasma pneumoniae (MP). Methods:The clinical data of 69 children with NP from January 2012 to June 2019 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed. Among them, there were 27 cases of bacterial infection NP (bacterial infection group) and 42 cases of MP infection NP (MP group). The clinical symptoms and signs, extrapulmonary complications, laboratory examination, imaging examination, treatment, outcome and follow-up were compared between 2 groups.Results:There were no significant differences in the rale rate, respiratory tone reduction rate and total fever time between 2 groups ( P>0.05); the incidence of shortness of breath in bacterial infection group was significantly higher than that in MP group: 77.8% (21/27) vs. 14.3% (6/42), and there was statistical difference ( P<0.01). There were no significant differences in the incidence of extrapulmonary complications between 2 groups ( P>0.05). The white blood cell, C-reactive protein (CRP), procalcitonin (PCT) and interleukin (IL) -10 in bacterial infection group were significantly higher than those in MP group, the tumor necrosis factor (TNF)-α and interferon (IFN) -γ in bacterial infection group were significantly lower than those in the MP group, and there were statistical differences ( P<0.05). There were no significant differences in neutrophils, lactate dehydrogenase (LDH) and IL-6 between 2 groups ( P>0.05). The time of necrosis in bacterial infection group was significantly earlier than that in MP group: (14.5 ± 4.2) d vs. (21.7 ± 6.4) d, and there was statistical difference ( P<0.05); there was no significant difference in the incidence of pleural effusion between 2 groups ( P>0.05), but the incidence of pleural effusion separation in bacterial infection group was significantly higher than that in MP group: 70.4% (19/27) vs. 2.4% (1/42), and there was statistical difference ( P<0.01). There were no significant differences in antibiotic application time, CRP recovery time and hospital stay between 2 groups ( P>0.05); the oxygen uptake rate and closed thoracic drainage rate in bacterial infection group were significantly higher than those in MP group: 88.9% (24/27) vs. 35.7% (15/42) and 25.9% (7/27) vs. 11.9% (5/42), the recovery times of WBC and PCT in bacterial infection group were significantly longer than that in MP group: (12.8 ± 4.1) d vs. (9.2 ± 2.0) d and (10.5 ± 2.5) d vs. (7.6 ± 1.9) d, the bronchoalveolar lavage rate was significantly higher than that in MP group: 25.9% (7/27) vs. 76.2% (32/42), and there were statistical differences ( P<0.01 or <0.05). There was no significant difference in the absorption time of necrotic lesions between 2 groups ( P>0.05). Conclusions:Compared with MP infection, the clinical process of bacterial infection NP is serious, the necrosis time appears earlier, and the course of disease is longer. However, most of the children with NP can obtain a good prognosis after active symptomatic and antiinfective treatment.

Objective To evaluate the efficacy and safety of caspofungin in the treatment of invasive fungal disease (IFD) in advanced age patients. Methods A retrospective analysis of the clinical data was conducted. IFD patients who had received caspofungin treatment in elderly wards were included. Results From January 2007 to August 2009, 29 IFD patients aged 80-100 years (mean 89 ) were treated with caspofungin. Except that one patient dead on the first drug administration day, there were 28 evaluable patients, 13 were cured (46.4%), 6 were markedly improved (21.4%), 3 progressed (10.8%) and 6 dead (21.4%). The overall effective rate was 67. 8%. Of 13cured patients, 12 were Candida bacreremia, 1 was Candida albicans disease of lung. Of 6 dead patients, 2 were Candida bacteremia, 1 was Candida albicans disease of lung and 3 was suspected of lung IFD. One patient performed that alanine aminotransferase was increased, considering drug-related impairment of liver function. Conclusions Caspofungin is effective and safe in the treatment of IFD in advanced age patients.

Objective To establish the quality standard for Shanzhajing Jiangzhi tablet by HPLC .Methods Samples were analyzed on a Agilent Zorbax SB C18 column(250 mm × 4 .6 mm ,5μm) with methanol and 0 .06 mol/L ammonium acetate (85∶15)as mobile phase at the flow rate of 0 .8 ml/min .The wavelength and column temperature were set at 210 nm and 25 ℃ ,respectively .Results The calibration curve showed a good linear relationship within the range of 0 .124-2 .48 μg for oleanolic acid (r=0 .999 7) and 0 .498-9 .96 μg for ursolic acid (r=0 .999 8) .The average recovery ratio of the oleanolic acid and ursolic acid were 96 .9% (RSD=1 .26% ) and 100.4% (RSD=2 .6% ) ,respectively .Conclusion The method was proved to be good at evaluation effectiveness and practicality .

Small cell lung cancer is the most common primary neuroendocrine malignancy of the lung and is characterized by high malignant degree,rapid doubling time,easy metastasis in early stage and poor prognosis.Accurate staging of small cell lung cancer can formulate personalized therapeutic plans and improve the prognosis of patients.PET/CT can obtain metabolism and anatomical images of the whole body in one scan and improve the diagnostic accuracy and integrity.PET/CT has been widely applied to clinical practice now.PET/CT will play a more and more important role in diagnosis,staging,treatment and prognosis assessment of patients with small cell lung cancer.The value of PET/CT in staging and treatment of small cell lung cancer was reviewed in this article.

Objective:To investigate the effect of activin A and nerve growth factor ( NGF) NGF on stimulating neurite outgrowth of dorsal root ganglia(DRG)of the embryonic chicken.Methods:In this study,we observed that activin A and NGF together induced neurite outgrowth of DRG and kept survival of DRG neurons by the primary cultured DRGs from embryonic day 8 ( E8 ) chicken.calcitonin gene-related peptide(CGRP)CGRP mRNA expressions were analyzed by RT-PCR.Results: The DRG treated with activin A +NGF had obvious neurite outgrowth ,compared with only NGF group on day 3,and the number of living DRG neurons also increased.Activin A +NGF up-regulated the mRNA expressions of CGRP in DRG.Conclusion:The Data demonstrated that activin A with NGF can synergistically stimulate DRG neurite outgrowth and maintain the DRG neurons survival , suggesting that it is more effective that NGF and activin A together treat the associated disease of nerve system.

Objective:To summarize the prenatal diagnostic characteristics of monogenic global developmental delay/intellectual disability(GDD/ID) pedigrees.Methods:This study retrospectively collected the prenatal molecular diagnostic results of 43 pedigrees that were affected with monogenic GDD/ID in the genetic counseling clinic of Peking University First Hospital from January 2015 to June 2019. The results of prenatal molecular tests were validated after birth or pregnancy termination. Pregnancy outcomes and healthy condition of the offspring were followed up. All data were analyzed by descriptive statistical analysis.Results:Among the 43 pedigrees, 24 were affected with autosomal recessive inheritance (AR) GDD/ID, in which six (25%) fetuses were found to carry two pathogenic variants; 13 (55%) had only one pathogenic variant; five (20%) did not harbor any variant. GDD/ID inherited in an autosomal dominant inheritance (AD) pattern was found in 13 pedigrees, in which 11 fetuses carried no variants while the other two fetuses had the same variants as the proband had (in one pedigree, a low-level variant was detected in the peripheral blood sample of the father while absent in peripheral blood samples of parents in the other pedigree, so it was suspected that the variants of these two affected fetuses were inherited from parental mosaicism). In the other six pedigrees with X-linked inheritance (XL) of GDD/ID, one male fetus was found to harbor the pathogenic variant, while no variants were detected in the others. Maternal contamination was excluded in all prenatal samples using short tandem repeat for linkage analysis. Postnatal validations were consistent with the prenatal tests. All nine affected fetuses were terminated, and the other thirty-four children were delivered and in good health.Conclusions:Prenatal molecular diagnostic test is an effective method to detect pathogenic variants during the first and second trimesters for pedigrees affected by monogenic GDD/ID. For pedigrees affected with AD or XL patterns caused by de novo mutations, potential parental mosaicism should be noted and prenatal diagnostic tests are also recommended.

Background The operation mode of automobile manufacturing industry (AMI) makes workers have different degrees of occupational stress and burnout, which may lead to negative emotions and depressive symptoms. Objective To study the relationship between occupational stress, job burnout, and depressive symptoms in AMI workers. Methods In this study, 1300 workers from a Guangzhou AMI company were selected as subjects by cluster random sampling method. Occupational stress, job burnout, and depressive symptoms of the workers were assessed by using the Effort-Reward Imbalance (ERI) questionnaire, the Maslach Burnout Inventory general survey questionnaire, and the Patient Health Questionnaire-9, respectively. Hierarchical regression was used to analyze the effects of occupational stress and job burnout on depressive symptoms in AMI workers. Mediating effect model was used to analyze the mediating effect of job burnout on the relationship between occupational stress and depressive symptoms. Results There were 1300 questionnaires distributed, 1228 valid questionnaires collected, with a 94.5% recovery rate. The ERI ratio of 1228 AMI workers was 1.06±0.72, and the positive rate of occupational stress was 37.3% (458/1228). The score of job burnout was 2.18±1.37, and the positive rate of job burnout was 62.6% (769/1228). The score of depressive symptoms was 10.27±6.42, and the positive rate of depressive symptoms was 47.1% (578/1228). The dimensional scores of effort and over-commitment in occupational stress as well as emotional exhaustion and depersonalization in job burnout of AMI workers were positively correlated with the depressive symptom scores (r_s=0.415, 0.571, 0.573, 0.593, P＜0.05). The dimensional scores of reward and personal achievement were negatively correlated (r_s=−0.454, −0.339, P＜0.05). The percentages of variance in depressive symptoms score explained by occupational stress and job burnout were 26.7% and 16.6%, respectively. Job burnout had a partial mediating effect between the three dimensions of occupational stress and depressive symptoms, and the mediating effect values were −0.2832 (95%CI: −0.3250– −0.2434), 0.3553 (95%CI: 0.3071–0.4041), and 0.4193 (95%CI: 0.3681–0.4725), respectively. Conclusion AMI workers' occupational stress affects job burnout, but also indirectly affects depressive symptoms. Job burnout partially mediates the association between occupational stress and depressive symptoms. Reducing occupational stress and burnout levels of AMI workers may alleviate depressive symptoms.

Objective To establish a HPLC method for simultaneous determination of oleanolic acid and ursolic acid and provide the basis for quality control of Hawthorn extract .Methods Chromatographic separation was performed on Agilent Zorbax SB C18 column(250 mm × 4 .6 mm ,5 μm) with mobile phase of methanol (A)-0 .06 mol/L ammonium acetate solution (B) (85∶15 ,V/V ) under isocratic elution for 30 min .The flow rate was set at 0 .8 ml/min and the detection was set at the wavelength of 210 nm .Results Oleanolic acid and ursolic acid showed good linearity (r> 0 .999 5) in the ranges of 0 .496-2.480 g and 0 .498-9 .960 g ,respectively .Repeatability ,precision ,recovery and stability were conform to the method valida-tion requirements of China Pharmacopoeia .Conclusion The method could provide the basis for the quality control of Hawthorn extract and its preparation .