Objective To observe the value of artificial neural network(ANN)model based on recursive feature elimination-support vector machine(RFE-SVM)for differentiating ductal carcinoma in situ(DCIS)and DCIS complicated with microinvasion(DCISM).Methods Totally 296 female patients with single breast cancer(244 cases of DCIS and 52 cases of DCISM)were retrospectively collected as training set.Then 120 female patients with single breast cancer(87 cases of DCIS and 33 cases of DCISM)were prospectively enrolled as validation set.The general data,mammography and MRI findings were compared between sets.The optimal feature subsets for establishing ANN model were screened.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of ANN model for differentiating DCIS and DCISM.Results Ki-67 index,the minimum apparent diffusion coefficient(ADCmin),nuclear grade,ADCheterogeneity,maximum diameter of lesion,patient's age,P63,lesion enhancement type,calcification status and necrosis were the selected top 10 optimal feature subsets.The accuracy,sensitivity,specificity,positive predictive,negative predictive and AUC of ANN model for differentiating DCIS and DCISM was 91.55％,63.46％,97.54％,84.62％,92.61％and 0.950 in training set,respectively,while was 80.00％,69.70％,83.91％,62.16％,87.95％and 0.896 in validation set,respectively.The calibration curves of ANN model were consistent with the ideal curves in both training and validation set(P=0.355,0.480),which also expressed high clinical net benefit.Conclusion ANN model based on SVM-RFE could be used to differentiate DCIS and DCISM effectively.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

ObjectiveTo explore the nursing students' experience of participation in group resuscitation workshop. MethodsFrom July to September of 2018,12 nursing interns in the Emergency Department of a Class Ⅲ Grade A hospital in Zhengzhou were recruited to participate in the study by purposive sampling and semi-structured interviews were conducted. The data obtained were analyzed by Colaizzi method. ResultsNursing students' experience of participation in the team recovery workshop can be summarized into three themes:teamwork awareness, independent learning ability and confidence,and stress and response. ConclusionsThe workshop promotes nursing students' sense of teamwork and stimulates their subjective initiative and ability to learn. It is suggested that nursing clinical education workers should attach importance to the various pressures faced by students and provide support from various angles.

Objective To study the thalamic metabolic alterations and its correlation with cognitive impairment in patients with cerebral small vessel disease(CSVD).Methods The cognitive function of 34 patients with CSVD and 26 matched volunteers were evaluated by Montreal cognitive assessment(MoCA), and received single voxel 1H-MRS examination to detect the content of NAA,Cho and Cr,and record the ratio of NAA/Cr and Cho/Cr on bilateral thalami.The differences of NAA/Cr, Cho/Cr on bilateral thalami between the two groups were compared, and the correlation between NAA/Cr,Cho/Cr and MoCA total score and its sub-items score in CSVD group were analyzed.Results ①The MoCA of total score as well as its sub-items such as visual space and executive ability,memory,attention and language for CSVD group were significantly lower than that for the control group(P<0.05);②NAA/Cr on bilateral thalami in CSVD group were both lower than that in the control group(left 1.57±0.18,1.68±0.17,t=2.46,P=0.02;right 1.66±0.21,1.78±0.19,t=2.23,P=0.03), the differences were statistically significant (P<0.05);there were no significantly differences in the ratio of Cho/Cr between the two groups(P>0.05);③In CSVD group, the ratio of NAA/Cr on both bilateral thalami were significantly positively correlated with MoCA score (left r=0.83,right r=0.79,P<0.05)as well as visual space and executive ability(left r=0.65,right r=0.46,P<0.05), memory(left r=0.59, right r=0.50, P<0.05), attention(left r=0.42, right r=0.52, P<0.05),language(left r=0.52, right r=0.41, P<0.05), abstraction(left r=0.47, right r=0.40, P<0.05), orientation(left r=0.48,right r=0.42, P<0.05),Cho/Cr were not significantly correlated with MoCA total score and its sub-items(P>0.05).Conclusion The thalamic neuron has been damaged and dysfunctioned in patients with CSVD,and this metabolic abnormality may be related to a wide range of cognitive impairment in CSVD patients.

Objective To assess the efficacy of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the breast in the detection of residual lesions of early stage breast carcinoma after lumpectomy. Methods 53 patients with breast masses confirmed to be malignant tumors by pathology after lumpectomy underwent the dynamic contrast-enhanced breast MR imaging and then further surgical treatment by lumpectomy. The DCE MRI-based diagnoses were compared to the results of pathological analyses after the second lumpectomy. Results 17 (32%) cases were detected with abnormal enhancement. 8 cases presented mass-like enhancements , and 6 of them showed tumorous residuals (P < 0.01). 6 presented focal enhancements, taking up 35% and one of them was confirmed pathologically to have tumorous residuals (P < 0.01). 3 cases presented mass-like enhancement, taking up 18% and 2 of them were confirmed with cancerous residuals . MR dynamic enhancement showed 68% of the them presented no abnormal enhancements in the breast and 33 of themhad no residual cancer , taking up 92%. 3 of them were confirmed with tumorous residuals , taking up 8%. The The positive predictive value and negative predictive value of DCE MR imaging for diagnosing residual malignant lesion were 52% and 92%, respectively . Conclusion The dynamic contrast-enhanced MRI of breast is helpful for evaluating residual malignant lesion after lumpectomy and affects positively subsequent treatment.

Objective:To investigate the correlation between the breast cancer MRI schedule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy, and its clinical significance in the guidance of formulating operation plan. Methods:Dynamic contrast-enhanced MRI scan was performed before chemotherapy and before surgery after a whole-range N-Acety-L-Cysteine (NAC) treatment in 55 patients with loco-regionally advanced breast cancer who received the neo-adjuvant chemotherapy. MRI sched-ule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy were obtained in the treatment, and the corre-lation between the two was analyzed. Results:Of the 55 patients, the unilateral breast mass was found in 54 and the bilateral lesion in 1. There were 56 neo-plastic foci in these patients. The mass-like enhanced image was seen in 24 of the total cases (43%), of which 23 presented with a centripetal shrinkage, 1 with an annular decline, (P<0.01). Multifocal mass-like enhancement image was found in 13 of the total cases, (23%), of which 2 centripetal shrinkages were the singular mass, 11 remained a multifocal lesion after the tumor shrinkage (P<0.01). The mass with peripheral non-tumor-like enhancement image was seen in 8 of the total cases (14%), of which 4 showed a centripetal shrinkage and another 4 a honeycombed multifocal decline (P>0.05). There were 11 of the total cases with non-tu-mor-like enhancement (20%), in which 4 assumed a centripetal shrinkage and 7 a honeycombed multifocal shrinkage (P<0.01). Conclu-sion:The tumor shrinking pattern and its accurate radiological image evaluation are the keys to the selection of breast-conserving sur-gery and the control of local recurrence after treatment of NAC regimen. We can predict the shrinking pattern through the type of the le-sion on baseline before NAC, which is important for the patients and surgeon to get a reasonable expectation in the subsequent treat-ments.

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.

In this paper, the changes of volatile oil and non-volatile ingredients in Cortex Magnolia Officinalis before and after primary processing were determined by an HPLC and a GC-MS method. The method is based on quantitative determination of three index ingredients, beta-eudesmol, honokiol and magnolol, and on qualitative fingerprinting analysis using HPLC and GC. Big differences were observed between processed and unprocessed samples according to their chromatographic fingerprinting data calculated by statistic software. Compared with unprocessed samples, the contents of honokiol and magnolol in processed samples increased, whereas the contents of beta-eudesmol and magnoloside A in processed samples decreased. Magnoloside A was isolated from this plant for the first time.
Drugs, Chinese Herbal ; chemistry ; Magnolia ; chemistry ; Quality Control ; Technology, Pharmaceutical ; methods

Objective: To study the apoptosis of T lymphocyte subsets of peripheral blood in systemic lupus erythematosus(SLE)and the correlated pathogenesis.Methods: The percentages of T lymphocyte subsets,the positive expression rates of Fas/FasL on T lymphocyte subsets,and the apoptosis of T lymphocyte subsets were determined by three-colorflow cytometry.The level of serum IL-10 was analyzed by ABCELISA.IL-10 antibody and FasL antibody were added respectively into the 48 hours' culture of 10 SLE patients' PBMCs in vitro,whose serum IL-10 significantly increased, and then, the changes of T lymphocyte subsets of SLE PBMCs were determined by three-colodlow cytometry.Results: 1)In SLE, mainly in hyperactive SLE, the apoptesis of CD4~+ T lymphocytes increased significantly(P＜0.05),and the ratio of CD4~+/CD8~+ decreased compared with normal controls,and the abnormal apoptesis of CD4~+ T lymphocytes had a positive correlation with the increased expression rates of Fas/FasL on CD4~+ and CD8~+ T lymphocytes(P＜0.05).2)The serum IL-10 level increased significantly in SLE (P＜0.01), expecially in hyperactive SLE, and serum IL-10 had a positive correlation with the level of serum anti-dsDNA antibodies, CD4~+/CD8 + ratio, and the positive expression rate of FasL on CD4 * T lymphocytes(P＜0.05).3)According to a tracking experiment on two different groups of SLE patients,we found that:with the stabilization of the illness,the level of serum IL-10 decreased significantly, the positive expression rate of Fas/FasL on T lymphocytes,particularly on CD4~+ T lymphocytes, reduced evidently,and the apoptosis of CD4~+ T lymphocytes decreased(P＜0.05).Conclusion: The abnormal activities of T lymphocytes, particularly of CD4~+ T lymphocytes from patients with SLE,which lead to AICD,cause the percentage of CD4~+ T lymphocytes and the ratio of CD4~+/CD8~+ to decrease,disorder immune response, and accelerate the process of SLE.As a key factor in modulating the positive expression rate of Fas/FasL on CD4~+ T lymphocytes,IL-10 plays an important role in causing SLE.

The effects of tree ages and geographic area on quality of bark of Magnolia officinalis (MO) and M. officinalis var. biloba (MOB) were studied. The volatile oils of samples extracted by a water stream distillation method were analyzed using a GC/MS method. The non-volatile ingredients of samples were determined by an HPLC method. Seven and twenty characteristic peaks were detected in the HPLC and GC fingerprint of MO, respectively, and the similar HPLC and GC fingerprint were showed in MOB. For samples collected in the same geographic area with different ages, the concentrations of active ingredients varied barely, whereas for those samples collected from different geographic area, differences on the concentrations of active ingredients were observed, for example, the concentrations of the amount of magnolol and honokiol in samples collected in Hubei province were higher than those collected in other areas. Big differences on the concentrations of active ingredients were found between MO and MOB, for MO, the ratio of honokiol/ magnolol was more than 0.7, whereas the ratio-was less than 0.7 in the case of MOB, and the concentrations of honokiol in MO were higher than those in MOB.
China ; Magnolia ; chemistry ; physiology ; Plant Bark ; chemistry ; physiology ; Plant Extracts ; analysis