Needle removal is an essential component of the entire acupuncture treatment process， and its standardization is directly related to clinical safety and quality control in acupuncture practice. However， in actual clinical work， due to factors such as the accelerated pace of diagnosis and treatment， increased workload， and changes in personnel collaboration patterns， missed needle removel still occurs from time to time， gradually becoming one of the potential safety hazards in acupuncture clinical practice. Based on the clinical practice， this article analyzes the occurrence characteristics and risk factors of missed needle removal， and finds that it is closely associated with personnel collaboration， the spatial distribution and identifiability of acupoints， and changes in patients' body positioning. A risk stratification framework is developed according to acupoint location， patient positioning， and diagnosis and treatment mode， and prevention and control strategies， including standardized handover， stratified checking， and information support proposed for different risk levels， aiming to provide a reference for standardized acupuncture and moxibustion practice and quality and safety management.

Abstract Through in-depth investigation into Japanese nutrition health educators post content, configuration, training mode, advanced education practice and the difficulties, the paper explores the effective ways of integrating nutrition health education into the school health education teacher and curriculum system as well as health promotion, so as to guide teachers and students to establish a correct concept of health, enhance health literacy and develop a healthy lifestyle. Additionally, the paper aims at providing suggestions for the construction of nutrition and health school as well as the future development of nutrition health education in China.

OBJECTIVE: To explore the molecular mechanism underlying 1,2-dichloroethane(1,2-DCE) induced apoptosis by screening differentially expressed proteins in human astrocytes( HAs). METHODS: HAs were cultured in complete medium with 1,2-DCE at various concentrations of 0-80 or 0-40 mmol/L. After 24 hours,apoptosis of HAs was evaluated using flow cytometry and staining with annexin Ⅴ-fluoresce in isothiocyanate and propidium iodide. An AAH-APO-1-2 protein chip was used to screen differentially expressed proteins and quantitative real-time polymease chain reaction(qRT-PCR) was used to verify related differentially expressed genes(DEGs). RESULTS: At 1,2-DCE concentrations of0-80 mmol/L,the total apoptosis rate of HAs increased with 1,2-DCE concentrations in a dose-dependent manner( P <0. 01). Seven different kinds of proteins were screened out by apoptotic protein chip. Among them,the expression of insulin-like growth factor-binding protein( IGFBP)-1,IGFBP-4 and cytochrome C( Cyto C) were up-regulated,while the expression of P27,cysteine aspartic acid specific protease-3( Caspase-3),B-cell lymphoma-2 interacting mediator of cell death( BIM) and BH3 interacting domain death agonist( BID) were down-regulated compared with the control group. The result of DEGs verified by qRT-PCR showed that the expression of mRNA of IGFBP-1,IGFBP-4 and Cyto C at 1,2-DCE concentrations of 40 mmol/L was up-regulated. This result was in consistent with the trend of target expression in the protein chip. The mRNA expression of Caspase-3,BIM and BID was also up-regulated. CONCLUSION: 1,2-DCE induces apoptosis of HAs through mitochondrial pathway.

Objective:To estimate the probability of N2 lymph node metastasis and to assist physicians in making diagnosis and treatment decisions.Methods:We reviewed the medical records of 739 patients with computed tomography-defined stage Ⅰ non-small cell lung cancer ( NSCLC ) that had an exact tumor-node-metastasis stage after surgery.A random subset of three fourths of the patients ( n =554 ) were selected to develop the prediction model.Logistic regression analysis of the clinical characteristics was used to estimate the independent predictors of N2 lymph node metastasis.A prediction model was then built and externally validated by the remaining one fourth ( n=185 ) patients which made up the validation data set.The model was also compared with 2 previously described models.Results:We iden-tified 4 independent predictors of N2 disease:a younger age, larger tumor size, central tumor location, and adenocarcinoma or adenosquamous carcinoma pathology.The model showed good calibration ( Hos-mer-Lemeshow test:P=0.923) with an area under the receiver operating characteristic curve (AUC) of 0.748 (95%confidence interval, 0.710-0.784) .When validated with all the patients of group B, the AUC of our model was 0.781 (95% CI: 0.715 -0.839) and the VA model was 0.677 (95% CI:0.604-0.744) (P =0.04).When validated with T1 patients of group B, the AUC of our model was 0.837 (95%CI:0.760 -0.897) and Fudan model was 0.766 (95% CI: 0.681 -0.837) (P <0.01) .Conclusion:Our prediction model estimated the pretest probability of N2 disease in computed tomography-defined stageⅠNSCLC and was more accurate than the existing models.Use of our model can be of assistance when making clinical decisions about invasive or expensive mediastinal staging procedures.

Objective To evaluate the efficacy and safety of induction concurrent chemoradiation therapy with weekly docetaxel and cisplatin(DP) for stage Ⅲ A-N2 lung cancer.Methods Eighteen patients diagnosed of stage Ⅲ A-N2 NSCLC in our center were enrolled from March,2011 to November,2013.The induction regimen consisted of 5 cycles of docetaxel(20 mg/m2) and cisplatin(20 mg/m2) administered intravenously on days 1,8,15,22 and 29 with concurrent thoracic radiotherapy in fractions of 1.8Gy,to a total dose of 45Gy.Patients proceeded to surgery,if no progressive disease occurred,followed by adjuvant chemotherapy with DP strategy.Results Eighteen patients were enrolled and 12 underwent surgery.The tumor response for the induction therapy was 1 CR,10 PRs,6 SDs and 1 PD.Five of 18 patients presented with level 3 or above adverse effects,among which were 2 neutropenia,1 liver toxicity,1 anemia and 1 lymph node infection.The median operation time was 290 min,intraoperative blood loss was 350 ml,length for postoperative drainage was 5 d,and time to discharge was 7 d.The mediastinal lymphnodedownstaging rate was 50％ (3 pN0 cases and 3 pN1 ones),92％ of the operated patients reached complete resection.One-year survival was 75.9％ and 1-year progression free survival was 49.2％.Conclusion Weekly docetaxel and cisplatin strategy in induction concurrent chemoradiotherapy for stage Ⅲ A-N2 NSCLC patients has been validated to be safe and effective.

OBJECTIVETo investigate the effect of CCM3 gene defection on lead induced cell genotoxicity in mouse embryonic fibroblasts.

METHODSC57 female mice were mated with CCM3 gene heterozygous male mice. E13.5 embryos were taken to isolate primary mouse embryonic fibroblasts. After genotyping, wild type and heterozygous cells were treated with different doses of lead acetate. Cell viability, genotoxicity and protein expression were detected by MTS assay, CB micronucleus method and Western blot, respectively.

RESULTSMouse embryonic fibroblasts with lead acetate treatment for 24 h, wild-type cells 100.00 µmol/L lead acetate-treated group (69.16±1.36) and the control group (100.00±2.33) compared to cells decreased by 30%, CCM3 heterozygous type cell 100.00 µmol/L lead acetate-treated group (87.16±5.50) and the control group (100.00±2.06) compared to cells decreased by 13%, the difference was statistically significant (F values were 98.59, 82.63, P<0.001). Lead acetate treatment after 48 h, wild-type cells 100.00 µmol/L lead acetate-treated group (51.99±5.62) and the control group (100.00±3.11) compared to cells decreased by 50%, heterozygous type cells 100.00 µmol/L lead acetate treatment group (66.33±4.06) and the control group (100.00±5.72) compared to cells decreased by 35%, the differences were statistically significant (F values were 82.63, 36.86, P < 0.001). The results of CBMN test showed that with increased dose, micronucleus cell rate of two genotypes showed an increasing trend, in the wild-type cells, the micronucleus cell rate (/1 000) for the control group, 29.6±2.2, 6.25 µmol/L dose group 47.3±6.6, 25 µmol/L dose group 55.5±9.1, 100.00 µmol/L dose group 66.8±3.5; heterozygous cells micronucleus cell rate (/1 000) for the control group, 35.3±5.6, 6.25 µmol/L dose of 50.0±8.3, 25.00 µmol/L dose group 57.0±8.5, 100.00 µmol/L dose group 58.8±2.1. Micronucleus cell rates (/1 000) were significant differences, in 100.00 µmol/L dose groups of two genotypes. Western blot results showed that wild-type cells CCM3 expression 100.00 µmol/L lead acetate-treated group (0.70±0.03) was 1.32 times higher than the control group (0.53±0.07), heterozygous cells CCM3 expression 100.00 µmol/L lead acetate-treated group (0.48±0.02) was 1.77 times higher than control group that of 0.27±0.04, there was statistically significant difference (F values were 14.77, 25.74, P < 0.001); wild-type cells γ-H2AX expression 100.00 µmol/L lead acetate-treated group (0.69±0.03) was 1.06 times higher than the control group (0.65±0.07), heterozygous cells γ-H2AX expression 100.00 µmol/L lead acetate-treated group (0.99±0.04) was 1.55 times higher than the control group CCM3 expression levels (0.64±0.06), there was statistically significant difference (wild-type cells: F = 7.08, P = 0.012, heterozygous type cell: F = 13.49, P = 0.002).

CONCLUSIONCCM3 gene may play a role in lead-induced genetic toxicity of mouse embryonic fibroblasts, CCM3 gene-lead interactions effects on mouse embryonic fibroblasts cell toxicity.

Animals ; Apoptosis Regulatory Proteins ; DNA Damage ; Embryo, Mammalian ; Female ; Fibroblasts ; Genotype ; Male ; Membrane Proteins ; Mice ; Mice, Inbred Strains ; Micronuclei, Chromosome-Defective ; Organometallic Compounds ; Proto-Oncogene Proteins

OBJECTIVETo analyze the clinical characteristics and follow up record of patients with synchronous multiple lung cancers (SMLC).

METHODSThe medical records of 1 868 lung cancer patients who underwent surgical treatments From January 2007 to December 2014 were reviewed, in which 103 patients were diagnosed SMLC by Martini and American College of Chest Physicians modified guideline. The average age was 60.5 years, including 34 male and 69 female patients. According to consolidation/tumor ratio (CTR) on thin-section computed tomography, 103 cases were classified into three groups: group A (multiple ground-glass opacities, CTR ≤ 50%), group B (with one solid dominant nodules, CTR > 50%), group C (with two solid dominant nodules). The surgical procedure was determined according to CT findings and respiratory function. The Kaplan-Meier method was used to analyze the duration of recurrence-free survival (RFS) and over-all survival (OS), and differences were assessed using the Log-rank test. Multivariate analysis using the Cox proportional hazards models was used to assess the potential independent effects on RFS or OS.

RESULTSThere were 38 patients in group A (36.9%), 40 patients in group B (38.8%) and 25 patients (24.3%) in group C. More female (73.7% vs. 48.0%, χ² = 4.291, P = 0.038), less smoker (21.1% vs. 44.0%, 2 = 3.770, P = 0.052), younger (56.2 years old vs. 65.9 years old, t = -4.172, P = 0.000) and less tumor size (1.24 cm vs. 2.31 cm, t = -4.573, P = 0.000) patients in group A than in group C. The 3, 5-year RFS were 80.3% and 64.9% for all patients, respectively. The 3, 5-year OS were 87.3% and 68.6% for all patients, respectively. The 3, 5-year RFS were 100% and 100% in group A, 77.7% and 51.8% in group B, 59.6% and 44.7% in group C (P = 0.029). No significance were found in OS between the three groups (P = 0.214). Multivariate Cox analysis demonstrated that size of dominant nodule larger than 2 cm (HR = 4.475, 95% CI: 1.138 to 17.604, P = 0.032) is associated with poor prognosis, whereas postoperative chemotherapy did not affect RFS.

CONCLUSIONSMultifocal ground-glass opacities and multiple solid lung cancers are different in nature. RFS of patients with SMLC is strongly affected tumor size. Surgical resection is effective and should be performed specifically to patients.

Female ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Tomography, X-Ray Computed ; Treatment Outcome

Objective Based on the mathematical models established in Department of Thoracic Surgery of Peking University People's Hospital for predicting malignant probability for solitary pulmonary nodules ( SPN),another continuous 145 patients with SPN were assessed to verify the accuracy of the model comparing with foreign models (Mayo model and VA model).Methods A retrospective cohort study in our institution included 145 patients with definite pathological diagnosis of SPN from Oct 2009 to Aug 2011,72 males and 73 females,average age (59.4 ± 12.2 ) years old.Clinical data included age,gender,course of disease,symptoms,history and quantity of smoking,time of smoking cessation,history of tumor,family history of tumor,tumor site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,and cavity.These raw data were incorporated into our model,Mayo model and VA model,the probability of malignant in every patient was calculated separately according to methods described before.The sensitivity and specificity of these 3 models were evaluated then.Afterwards,calibration of the 3 models was assessed by the Hosmer-Lemeshow (H-L) test.Discrimination was tested by calculating the area under curve ( AUC ) after the receiver operating characteristic (ROC) curve was drawn.Results 32.4％ (47 in 145 patients) of the nodules were malignant,and 67.6％ (98 in 145 patients) were benign in this group.Verified the accuracy of our model with sensitivity of 94.9％,specificity of 66.0％,positive predictive value of 85.3％ and negative predictive value of 86.1％.The H-L test showed good fitting in all models ( P ＞0.05 ).The AUC for our model was 0.874 ±0.035,and 0.784 ± 0.041 in Mayo model (P =0.004 compared to our model),0.754 ± 0.041 in VA model (P =0.002 compare to our model).And,there was not significant statistical difference between Mayo model and VA model (P ＞0.05 ).Our model has the best precision indexed by AUC,which were statistically significant differential compared with Mayo model and VA model.Conclusion The model established by our center has superior value than foreign counterparts in predicting the probability of malignant or benign in patients with SPN.

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of intrapulmonary tumors located adjacent to the central airway.MethodsThe study was retrospective,from September 2009 to September 2011,33 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA.Conventional bronchoscopic biopsy before EBUSTBNA was nondiagnostic in all cases.If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy,patients were subsequently referred for a surgical procedure.ResultsOf the 33 patients,EBUS-TBNA confirmed lung cancer in 29 cases (4 small cell lung cancer,25 non-small cell lung cancer).Four patients were not confirmed by EBUS-TBNA,3 cases were diagnosed as squamous cell carcinoma by thoracoscoopy or thoracotomy,the other one was a pulmonary inflammatory lesion diagnosed by thoracoscopy.The sensitivity,specificity,accuracy,negative predictive value and positive predictive value of EBUS-TBNA for the diagnosis of intrapulmonary lesions was 90.2％,100％,90.9％,25％,and 100％,respectively.The procedure was uneventful,and there were no complications.ConclusionEBUS-TBNA is an effective tool with a high yield for the diagnosis of intrapulmonary lesions located adjacent to the central airway.

Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic sarcoidosis.Methods The study was retrospective,from September 2009 to June 2011,35 patients with suspected sarcoidosis,with enlarged hilar or mediastinal lymph nodes on computed tomography ( ≥1.0 cm),underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 87 lymph node stations in 35 patients.Of the enlarged lymph nodes,64 (73.6％) were located in the mediastinal region and the remaining 23 ( 26.4％ ) around the hilar or interlobar area.A final diagnosis of sarcoidosis was made for 28 (80％) of the patients.In patients with a final diagnosis of sarcoidosis,EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 25 ( 89.3％ ) of the patients.EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic sarcoidosis of stage Ⅰ or Ⅱ.