Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Objective:To examine the effects of Zishenwan Prescription on bile acid metabolism in mice with diabetic encephalopathy; To explore its mechanism of improvement of diabetic encephalopathy.Methods:Male C57BL/6J mice were used to replicate the mouse model of type 2 diabetes mellitus by using high-fat chow and a single intraperitoneal injection of streptozotocin (120 mg/kg). The mice were screened for diabetic encephalopathy by using the Morris water maze test after 8 weeks of continuous stimulation with hyperglycemia, and were divided into model group and Zishenwan Prescription group according to random number table method, with 12 mice in each group. The mice in the Zishenwan Prescription group were treated with the crude extract of Zishenwan Prescription (9.36 g/kg) by gavage, and the normal group and the model group were treated with the same volume of distilled water once a day for 8 weeks. At the end of the treatment, Morris water maze test was used to investigate the cognitive function of diabetic encephalopathy mice; cresyl violet staining was used to detect the number of granule neurons in the hippocampus; serum and feces were collected to detect the content of bile acids by liquid-liquid coupling; hepatic bile acid synthase CYP7a1 and CYP27a1, farnesol X receptor (FXR), fibroblast growth factor 15 (FGF15), fibroblast growth factor receptor 4 (FGFR4), and ileocecal apical sodium-dependent bile acid transporter protein (ABST) mRNA levels were detected by using fluorescence quantitative PCR assay.Results:Compared with the model group, mice in the Zishenwan Prescription group had shorter evasion latency time ( P<0.05 or P<0.01), decreased time to first reach the platform ( P<0.01), increased number of times to traverse the platform ( P<0.01), and reduced neuronal cell damage in hippocampal area; mice in the Zishenwan Prescription group showed decreased serum and fecal total bile acid content ( P<0.05 or P<0.01); the liver CYP7a1 and CYP27a1 mRNA expressions increased ( P<0.01), and FXR and FGF15 mRNA expressions decreased ( P<0.01); ileal ABST mRNA expression decreased ( P<0.01). Conclusion:Zishenwan Prescription may regulate bile acid metabolism, inhibit FRX-FGF15/FGFR4 signaling and ABST expression to promote new bile acid synthesis and conjugated bile acid reabsorption, and thus improve cognitive function in diabetic encephalopathy mice.

Objective Construct a scientific and reasonable evaluation index system for clinical specialties of tradi-tional Chinese medicine in Shandong Province to provide a scientific basis for improving the service capacity of clini-cal specia lties of traditional Chinese medicine.Methods Based on relevant policies and literature research,the analytic hierarchy process and Delphi expert consultation method were used to determine the index system and its weight,and 509 clinical specialties of traditional Chinese medicine capacity levels of 178 medical institutions in Shandong Province were evaluated.Results A scientific and effective evaluation index system for clinical specialty capacity of traditional Chinese medicine in Shandong Province was constructed,with 23 secondary indicators in 5 dimen-sions.It comprehensively evaluats the service capacity and management level of orthopedics and traumatology de-partments of traditional Chinese medicine class hospitals in Shandong Province,uses orthopedics and traumatology as an example.Conclusion Driven by the dynamic monitoring of the evaluation index system,improve the service ca-pacity for clinical specialties of traditional Chinese medicine,guide it to strengthen the internal construction of tradi-tional Chinese medicine,and give full play to the advantages of traditional Chinese medicine characteristics.Increase the support for clinical specialties of traditional Chinese medicine in Shandong Province,and then promote the high-quality development of traditional Chinese medicine.

OBJECTIVE：To establish the fingerprint of wine-processed Schisandra chinensis ，and to conduct cluster analysis and principal component analysis. METHODS ：HPLC method was adopted. The determination was performed on Diamonsil C 18（2） column with mobile phased consisted of methanol-water （gradient elution ）at the flow rate of 1 mL/min. The detection wavelength was set at 250 nm，and the column temperature was 30 ℃；the injection volume was 10 μL. With schisandrol A as the reference peak，HPLC fingerprints of 15 batches of samples were drawn and their similarity were evaluated with Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition）. The common peaks were determined. Cluster analysis and principal component analysis were performed by using SPSS 22.0 statistical software. RESULTS ：There were 20 common peaks in 15 batches of samples ，and the similarities were 0.983-0.999；a total of 8 common peaks were identified ，namely 5-hydroxymethyl furfural，schisandrol A ，schisandrol B ，schisantherin A ，schisantherin B ，deoxyschizandrin，γ-schizandrin，pseudo-γ-schizandrin. The results of cluster analysis showed that 15 batches of wine-processed S. chinensis could be clustered into 4 categories. Among them，S1-S4 and S 14 were clustered into one category ，S9-S11 were clustered into one category ，S5，S7-S8，S12-S13 were clustered into one category ，and S 6 and S 15 were clustered into one category. The results of principal component analysis showed that the cumulative variance contribution rate of first four principal component s was 85.381％；the classification results were basically consistent with the results of cluster analysis. Compared with S. chinensis ，5-hydroxymethyl furfural was newly found in S. chinensis after wine-processing ，with high content ；but there was no significant difference in the other chromatographic peaks. CONCLUSIONS：The established HPLC fingerprint is simple and easy to operate ，combined with cluster analysis and principal component analysis ，can be used for quality control of wine-processed S. chinensis decoction pieces.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective: To analyze the impact of Pringle’s maneuver on postoperative serum inflammatory mediator levels and prognosis in hepatitis B virus-related hepatocellular carcinoma (HBV related HCC) patients. Methods: A retrospective study was conducted on 157 HBV related HCC patients who underwent treatment at the Chinese PLA General Hospital from January 2016 to December 2017. There were 128 males and 29 females. The mean age was (54.5±12.1) years. These patients were divided into 106 patients who underwent Pringle’s maneuver (the Pringle’s maneuver group). The remaining patients were in the Occlusion-free group. All patients were detected inflammatory mediator levels including the various interleukins (IL) and were regularly followed up. The recurrence-free survival was evaluated by the Kaplan-Meier method, and compared with the log-rank test. The relationship between the Pringle’s maneuver and risks of postoperative tumor recurrence of these patient were estimated by the univariate and multivariate Cox regression models. Results: On postoperation day 1 and day 3, the serum IL-1 and IL-6 levels of the Pringle’s maneuver group were significantly higher than the Occlusion-free group [5.0(5.0, 12.0)ng/L vs. 5.0(5.0, 5.0)ng/L], [122.0(74.5, 173.8)ng/L vs. 80.0(40.0, 120.0)ng/L]; [5.0(5.0, 10.0)ng/L vs. 5.0(5.0, 5.0)ng/L], [78.3(42.8, 138.5)ng/L vs. 48.1(30.1, 75.0)ng/L]. On day 5, the serum IL-1 and IL-8 levels were also significantly higher than the Occlusion-free group [5.0(5.0, 5.3)ng/L vs. 5.0(5.0, 5.0)ng/L], [100.6 (44.2, 186.5)g/L vs. 68.0(36.3, 112.0)ng/L] (all P<0.05). There were 42 and 27 patients who did not develop recurrence in the Pringle’s Maneuver group and the Occlusion-free group, respectively. The recurrence-free survival rates of the Pringle maneuver group and the Occlusion-free group were 40.0% and 52.9%, respectively. There were no significant differences between the two groups (P>0.05). The multivariate Cox regression model suggested that there was no significant correlation between Pringle’s maneuver and recurrence free survival of these patients with HBV related HCC. Conclusions Pringle’s maneuver could significantly elevate the postoperative serum IL-1, IL-6, IL-8 levels, but it was not related with an increased risk of postoperative tumor recurrence.

Objective To analyze the clinical features of intrahepatic biliary cystadenoma and cystadenocarcinoma.Methods Sixteen patients from Dec.2008 to Dec.2013 were retrospectively reviewed to investigate their clinical manifestations,image features,treatment and prognosis.Results Intrahepatic biliary systadenoma and occured occurred primarily in middle-aged women with no typical clinical manifestations.Image examination is the key method in diagnosis.Surgery is the only method to cure the disease.The procedure depends on its location,and its prognosis is related to complete surgical resection.Conclusion Intrahepatic biliary cystadenoma and cystadeno-carcinoma is a rare tumor occuring mostly in middle-aged women.Image examination is the key method in diagnosis.Complete surgical resection contributes to its better prognosis.

OBJECTIVETo investigate the influence of three primers on the shear bond strength between cast titanium (Ti) and composite resin.

METHODSThe disks (n = 40) were cast by commercially pure (CP) Ti, which diameter were 8 mm and thick were 3 mm. The titanium surfaces were polished with silicon carbide sand papers under running water and then treated by sandblasting and acid (4%HF) etching. They were divided into four groups: control group (group A), treated with KH-570 (group B), treated with Alloy Primer (group C), treated with Metal photo primer (group D). After treatment, the specimens were evaluated for their shear bond strengths by universal testing machine. The values were statistically analyzed. The fractured surfaces were observed by scanning electron microscope (SEM).

RESULTSThe shear bond strengths of group A, B, C, D were (9.773 +/- 0.67), (11.463 +/- 0.82), (14.224 +/- 0.75), (13.157 +/- 0.73) MPa. There were significant differences in bond strength between A and B, C, D (P < 0.01). B and C, D had significant differences (P < 0.01). C and D had no significant differences (P>0.05).

CONCLUSIONKH-570, Alloy Primer, Metal photo primer significantly improve the bond strength of ceramage composite resin to cast titanium. KH-570 group bonding strength is lower than the the Alloy Primer group and Metal photo primer group.

Objective To investigate the influence of three primers on the shear bond strength between cast titanium (Ti) and composite resin. Methods The disks (n=40) were cast by commercially pure (CP) Ti,which diameter were 8 mm and thick were 3 mm. The titanium surfaces were polished with silicon carbide sand papers under running water and then treated by sandblasting and acid (4%HF) etching. They were divided into four groups: control group (group A), treated with KH-570 (group B), treated with Alloy Primer (group C), treated with Metal photo primer (group D). After treatment, the specimens were evaluated for their shear bond strengths by universal testing machine. The values were statistically analyzed. The fractured surfaces were observed by scanning electron microscope (SEM). Results The shear bond strengths of group A, B, C, D were (9.773±0.67), (11.463±0.82) , (14.224±0.75), (13.157±0.73) MPa. There were significant differences in bond strength between A and B, C, D (P<0.01). B and C, D had significant differences (P<0.01). C and D had no significant differences (P>0.05). Conclusion KH-570, Alloy Primer, Metal photo primer significantly improve the bond strength of ceramage composite resin to cast titanium. KH-570 group bonding strength is lower than the the Alloy Primer group and Metal photo primer group.