0.05).The major toxicity and side effects were bone marrow inhibition,gastrointestinal reaction and mucosal reaction.The difference of hematologic toxicity and gastrointestinal between the two groups was statistically significant(P0.05).The GEM group could be well tolerated for the concurrent chemoradiotherap of patients with stage Ⅲ～Ⅳa nasopharyngeal carcinoma(NPC).

Objective: To investigate the effect of combined hypoxia and high fat diet (HFD) on endothelial nitric oxide synthase (eNOS)/nitric oxide (NO) of myocardium in experimental rats with its possible mechanisms.
Methods: A total of 60 male SD rats were randomly divided into 3 groups, n=20 in each group. Control group, the rats were fed by normal diet with normal oxygen condition. Hypoxia group, the rats were fed by normal diet with simulated 5000m altitude oxygen condition. Combined hypoxia and HFD (H+HFD) group, the rats were fed by HFD and simulated 5000m altitude oxygen condition. All animals were treated for 4 weeks and peripheral blood and myocardium specimen were collected. Hemoglobin was examined by automatic blood cell analyzer, plasma malondialdehyde (MDA) was measured by TBA method, superoxide dismutase (SOD) activity was detected by WST-1 method, mRNA and protein expressions of eNOS were examined by real time PCR and Western blot analysis respectively, the myocardium nitrates and nitrites (NOx) was measured by nitrate reductase method.
Results: Compared with Control group, Hypoxia group and H+HFD group had increased mRNA and protein expressions of eNOS, H+HFD group had lower NOx levels than the other 2 groups P<0.05. Compared with Hypoxia group, H+HFD group showed obviously increased total cholesterol, LDL-cholesterol and decreased SOD activity, diseased MDA level P<0.05.
Conclusion: Upon hypoxia alone, H+HFD may further reduce NOx level of myocardium, it implies aggravated chronic hypoxia impairment, which might be related to dyslipidemia and lack of anti-oxidative ability in experimental rats.

Objective To investigate the efficacy and safety of fludarabine cytarabine and granulocyte colony stimulating factor (FLAG) chemotherapy on adult relapsed or refractory adult acute lymphoblastic leukemia (ALL) patients.Methods Twenty adult patients with relapsed or refractory ALL were treated with salvage therapy which was combined of fludarabine,cytarabine and granulocyte colony stimulating factor (FLAG).Another 20 cases in control group were treated with primal induction regimen and idamycin combined with etoposide and high-dose methylprednisolone.Sides effects of 2 groups were compared and FCM was used to investigate the cells with leukemia associated with immunophenotype,final comparing with bone marrow morphology.Results Hematologic toxicity was similar both in the treatment group and control group.Nonhematology complications consisted of heart and liver toxicity (1/20 and 9/20) were weaker than those in control group (4/20 and 1/20),which were mild to moderate and could be alleviated with supportive therapy.The median overall survival was no significant difference between both sides,eights patients (40.0 ％) who achieved complete remission received salvage therapy,the disease-free survival and the median overall survival were 6 months (range 4-30 months) and 11 months (range 9-30 months),respectively.Seven patients (35.0 ％) achieved complete remission in the treatment group,the disease-free survival and the median overall survival were 4 months (range 3-30 months) and 9 months (range 9-30 months) for 7 patients,respectively.In the treatment group early recurrence [5.0 ％ (1/20)] and outside marrow of recurrence rate (0)were lower than in control group [20.0 ％ (4/20) and 10.0 ％ (2/20)].Conclusion FLAG is a well-tolerated regimen for adult relapsed or refractory ALL patients which enables patients to receive allogeneic stem cell transplantation.

BACKGROUNDTo analyze clinicopathological correlation of detection of lung cancer micrometastasis in regional lymph nodes (LNs) by reverse transcriptase-polymerase chain reaction (RT-PCR).

METHODSRegional LNs (n=261) were obtained from 40 patients with lung cancer who underwent lobectomy. Each LN was bisected. Half of each LN was subjected to histological examination (HE) and the other half was subjected to RT-PCR amplification of CK19 mRNA.

RESULTSIn 18 of 40 patients, the metastasis in regional LNs was found by both HE and RT-PCR. Of 22 N0 diseases diagnosed by HE, 6 (27%) were found to express CK19 mRNA in regional LNs. According to the results of regional LNs metastasis in 40 patients by CK19 RT-PCR, the presence of the CK19 product in LNs was related to tumor size (Chi-square=5.76, P < 0.025), the presence of tumor vascular invasion (Chi-square=3.88, P < 0.05), cell differentiation of the tumor (Chi-square=7.08, P < 0.01) and P-TNM stages (Chi-square=7.42, P < 0.01). In the histologically node-negative patients, lymph node micrometastasis was significantly related to tumor size (P=0.038, exact test) and P-TNM stage (P=0.01, exact test). However, the results of routine histological examination did not show the above clinicopathological correlation (P > 0.05).

CONCLUSIONSThe RT-PCR method is superior to routine histological examination in detecting metastasis in LNs. The micrometastasis in LNs can be detected accurately by RT-PCR. It is helpful for screening the patients in whom the early subclinical metastasis exists and disclosing the intrinsic rule of malignancy metastasis.

Objective: To investigate the quality and influencing factors of direct drinking water in schools in Nanjing City, so as to provide basis for management of school drinking water. Methods: From April to July 2023, direct drinking water equipment from 146 primary and secondary schools were selected from Nanjing City using a stratified random sampling method and tested for colony forming units (CFU) and permanganate index. Mann-Whitney U test was used to compare the differences between groups, and multiple linear regression was used to analyze the influencing factors. Results: The CFU and permanganate levels of school direct drinking water in Nanjing City were 1.00(0.00,15.50)CFU/mL and 0.47(0.26, 0.75)mg/L, respectively. The CFU level increased when the filter replacement time exceeded 3 months and when the water source was piped, while the permanganate index increased when the filter replacement time exceeded 3 months and using activated carbon technology ( Z =-2.21, -3.92, -2.31, -8.45 , P <0.05). The results of multiple linear regression analysis showed that the replacement time of filter element exceeding 3 months was positively correlated with the CFU level, and the process type involving activated carbon, a laid pipe network and a filter replacement time exceeding 3 months were positively correlated with the permanganate index( β =167.08, 0.32, 0.35, 0.11, P ＜0.05). Conclusions There are certain problems with the water quality of primary and secondary school direct drinking water in Nanjing City. Schools should promptly replace the filter and maintain the drinking water equipment to ensure the hygiene and safety of campus water quality.

Objective? To develop the Traditional Chinese Medicine (TCM) nursing skill training program for community nurses and to evaluate its effects based on Kirkpatrick Model. Methods? Totally 83 community nurses from 2 districts of Hangzhou between April and August 2017 were selected using convenient sampling and divided into the control group (n=42) and the observation group (n=41). Community nurses in the control group received conventional training, while community nurses received TCM nursing skill training, and its effects were evaluated in terms of reaction, learning, behavior and result layers based on Kirkpatrick Model. Results? There was no statistically significant difference in general information and student analysis data between the two groups (P＞0.05). The attendance rates of both groups were above 85% after the training, and the total satisfaction, theoretical performance of TCM and skill examination of the observation group scored (95.05±5.32), (79.90± 6.03) and (88.52±2.47), respectively. The scores of self-evaluated behavior and others-evaluated behavior were (44.75±3.58) and (40.15±2.85); and patients＇ satisfaction score was (95.35±3.61), higher than that of the control group (P＜0.05), which was (91.95±4.56). The number of TCM nursing items launched in the departments to which the two groups belonged to was 3.(5 3.00, 4.75) and [3(?2, 4);(P＞0.05)]. Conclusions? The TCM nursing skill training program can benefit community nurses in terms of reaction, learning, behavior and result layers, which is worth promoting in clinical practice.

Objective To explore the effects of multidisciplinary cooperative continuous nursing on psychological state and life quality of patients with breast cancer. Methods A total of 105 patients with breast cancer who were to be discharged within February to June 2016 were selected and divided into observation group (n=54) and control group (n=51) randomly. The control group received only routine discharge health education, while the observation group received the multidisciplinary cooperation continuous nursing performed by nurses, doctors, psychologists and nutritionist through wechat, QQ software, telephone interview and patients' clubs. After follow-up for 12 weeks, patients of the two groups were evaluated by self-rating anxiety scale (SAS), self-rating depression scale (SDS) and function assessment of cancer therapy-breast cancer (FACT-B). Results The scores of SAS and SDS in the observation group were (34.18±5.34), (35.73±4.26), and (56.35±7.12), (49.36±6.32) in the control group respectively. The differences were statistically significant (t=21.890,18.340; P<0.01). The total score of life quality of the observation group and the control group was (87.21±6.53) and (82.65±5.34) respectively, with statistical significance (t=3.330, P< 0.01). Conclusions Implementing of multidisciplinary cooperative continuous nursing in patients with breast cancer can reduce anxiety and depression, improve patients' psychological state and quality of life.

Objective:To examine the impact of berberine on polycystic ovary syndrome (PCOS) in mice, and to investigate the effects of berberine on the intestinal flora and the intestinal flora on PCOS.Methods:A mouse model of PCOS was established by administering dehydroepiandrosterone in combination with high fat diet, and the mouse model was given a berberine treatment. The study consisted of a blank control group (C group), a PCOS model group (M group) and a berberine treatment group (T group). During the experiment, the mice were closely monitored through timed body weight measurements and estrous cycle monitoring; intraperitoneal glucose tolerance test and insulin tolerance test were done. Upon completion of the pharmacological intervention, the wet weights of liver, ovary and fat deposits of mice were assessed and subjected to HE staining to confirm the success of PCOS modeling and the efficacy of berberine. Additionally, fecal samples were analyzed for intestinal flora through 16S rRNA analysis.Results:The PCOS model was established successfully, berberine alleviated the disturbance of estrous cycle in mice, and significantly alleviated fat accumulation and metabolic abnormalities of glucose in mice. The cross-sectional area of fat pad cells in T group was (2 858±146) μm2, which was significantly lower than that in M group [(9 518±347) μm2], and the difference was statistically significant ( P<0.001). The blood glucose levels in T group were significantly lower than those in M group ( P<0.05). The composition and structure of intestinal flora in mice of M group with PCOS (compared with C group) and in mice of T group after berberine intervention (compared with M group) were significantly altered. However, alpha diversity did not change significantly among three groups ( P>0.05). Conclusion:Berberine could alleviate PCOS by intervening in the alterations of gut microbiota.

OBJECTIVE：To study the effects of chrysophanol on the activa tion of microglia and the expression of inflammatory factors in cerebral ischemia model rats. METHODS ：SD rats were randomly divided into sham operation group ， model group and chrysophanol high ，medium，low dose groups [7.88，3.94，1.97 mg/（kg·d）]，with 20 rats in each group （the number was complemented in cases of death or unsuccessful modeling during modeling process ）. Except for sham operation group ， middle cerebral artery occlusion model was established in other groups by improved thread method. After 2 hours of ischemia ， sham operation group and model group were intraperitoneally injected with 1 mL normal saline ，and each administration group was intraperitoneally injected with 1 mL corresponding drug ，once a day ，for 7 consecutive days. After last medication ，the score of neurological impairment was recorded ；cerebral infarction of rats was observed by TTC staining ，and the percentage of cerebral infarction area was calculated. The expression of Iba- 1 positive cells in ischemic penumbra of rats was observed by immunofluorescence staining. The expression of Notch- 1，TNF-α and ICAM-1 in the ischemic penumbra of rats were detected by Western blotting assay. RESULTS ：In sham operation group ，there was no infarction area in the brain tissue ，and the Iba- 1 positive cells in the ischemic penumbra were few and branched. Compared with sham operation group ，the infarction area of cerebral tissue in rats was obvious in model group ； the 052）number of Iba- 1 positive cells in ischemic penumbra were 〔ZQ2017003〕） increased significantly ，and they were in amoeba or round shape；the neurological impairment score ，the percentage of cerebral infarction area ， relative expression of Notch- 1， TNF-α and ICAM-1 protein in ischemic penumbra were increased significantly （P＜0.05）. Compared with m odel rats ，the infarction area of cerebral tissue in each dose group of chrysophanol was reduced to different extent ；the number of Iba- 1 positive cells in ischemic penumbra was decreased ；neurological impairment score ，the percentage of cerebral infarction area ，relative expression of Notch- 1，TNF-α and ICAM-1 protein were significantly decreased （P＜0.05 or P＜0.01）. CONCLUSIONS ：Chrysophanol has a certain protective effect on the brain tissue of cerebral ischemia model rats ，and can relieve the nerve injury. Its mechanism may be associated with inhibiting the activation of microglia and expression of inflammatory factors mediated by Notch pathway.

Background Drinking water contains a variety of chemicals that may pose certain health risks to the human body. Objective To evaluate carcinogenic and non-carcinogenic health risks of chemical pollutants in drinking water in Nanjing from 2014 to 2022. Methods According to the Standard examination methods for drinking water (GB/T 5750-2006) and the Standards for drinking water quality (GB 5749-2006), the conventional water quality indexes of finished water, tap water, and secondary water supply in Nanjing from 2014 to 2022 were monitored. The health risk assessment model recommended by the United States Environmental Protection Agency (US EPA) was used to assess the health risks of 16 chemicals [arsenic, cadmium, chromium (hexavalent), lead, mercury, selenium, cyanide, fluoride, nitrate nitrogen, trichloromethane, carbon tetrachloride, aluminum, iron, manganese, copper, and zinc] in drinking water through different routes (drinking water and skin contact) in different populations (adult males, adult females, and children). Region (urban and rural), water period (dry period and wet period), and water sample type (finished water, tap water, and secondary water supply) were stratified for analysis. Results From 2014 to 2022, a total of 4198 samples of drinking water were monitored in Nanjing, including 483 samples of finished water, 3313 samples of tap water, and 402 samples of secondary water supply. The pass rates of all indicators were above 99%. The health risk assessment results showed that the carcinogenic/non-carcinogenic risks of arsenic and lead presenting a trend of first increasing from 2015 and 2016 respectively, remaining relatively high for 3 and 4 consecutive years respectively, and then decreasing from 2018 and 2020 respectively before remaining stable; the carcinogenic risk of cadmium was much higher than that of other chemicals, and the risk was greater than 1.00×10⁻⁴ except for 2018 and 2019. The non-carcinogenic risks of drinking water in different populations (adult males, adult females, and children) under different exposure modes (intake of drinking water and skin contact) were less than 1. The values of carcinogenic risk via drinking water in total population and of cadmium intake via drinking water in all sub-groups (adult males, adult females, and children) were greater than 1.00×10⁻⁴. The carcinogenic/non-carcinogenic risk of drinking water was the highest in children, and the carcinogenic/non-carcinogenic risk via drinking water ingestion was higher than that via skin contact. The stratified analysis showed that the carcinogenic/non-carcinogenic risks of arsenic and cadmium in urban drinking water were higher than those in rural drinking water (P<0.05); the carcinogenic/non-carcinogenic risks of arsenic and trichloromethane in wet season were higher than those in dry season (P<0.05); the carcinogenic risks of cadmium in different types of water were all greater than 1.00×10⁻⁴; the health risks varied by chemicals and water sample types for the other chemicals, but all were within an acceptable level. Conclusion The non-carcinogenic risks and carcinogenic risks of selected chemical pollutants in drinking water in Nanjing City from 2014 to 2022 show decreasing or stable trends. Among the 16 chemicals, the carcinogenic risk of cadmium exceeds the acceptable range recommended by the US EPA, and the carcinogenic/non-carcinogenic risks of the remaining chemicals are within the acceptable ranges. Cadmium should be given priority attention in future risk management of drinking water.