Objective : To explore the correlation between the clinical, pathological, genetic features, prognosis, and tumor lymph node metastasis in patients with stage ⅠA-Ⅲ B lung invasive non-mucinous adenocarcinoma(INMA). Methods: A retrospective analysis was conducted on 67 eligible patients with INMA. Clinical data, histopathological assessments, and genetic testing were collected. Disease progression-free survival(PFS) was the primary endpoint through follow-up. The chi-square test or Fisher's exact test was used to analyse the correlation between tumour lymph node metastasis and clinicopathological and genetic characteristics. The Cox proportional hazards regression model and Kaplan-Meier method were used to analyse the impact of tumour lymph node metastasis on prognosis. Results: A total of 67 patients were included, aged 46-77 years, with a median age of 61 years. Age, gender, and smoking history were not significantly associated with tumor lymph node metastasis. Larger tumor diameter, tumor progression, and receiving postoperative adjuvant treatment were associated with tumour lymph node metastasis(P<0.05). Poorer differentiated tumors according to International Association for the Study of Lung Cancer(IASLC) grading system was more likely to have lymph node metastasis(P=0.043). There was no significant difference in the types of driver gene mutations and lymph node metastasis. However,EGFRmutations were more common in patients without lymph node metastasis, while co-mutations were more common in patients with lymph node metastasis. Lymph node metastasis was significantly associated with PFS. Patients without lymph node metastasis had a significantly better PFS compared to those with lymph node metastasis(P=0.002). Under different treatment conditions, patients without lymph node metastasis exhibited a significant advantage in PFS when untreated. While treatment showed a trend toward improved PFS, the difference did not reach statistical significance. Additionally, no significant differences in PFS were observed between patients with or without lymph node metastasis following chemotherapy or targeted therapy. Conclusion Lymph node metastasis in INMA patients is related to tumor size, progression status, and gene co-mutations, and is a key prognostic indicator affecting PFS.

Objective: To investigate the correlations among clinicopathological features, histopathological growth patterns and prognosis of extrapulmonary multiple metastatic(stage ⅣB) pulmonary adenocarcinoma with epidermal growth factor receptor(EGFR) mutations. Methods : A total of 488 eligible patients with adenocarcinoma of stage ⅣB. Clinicopathological data,EGFRgene mutation subtypes, metastatic sites, histopathological growth patterns and survival information were collected. The chi-square test(χ2test) and Fisher's exact probability method were used to detect the correlation between the metastasis status and various clinical characteristics; the Kaplan-Meier method was used to conduct survival analysis on the median Progression-Free Survival(PFS) under different clinical characteristics. Cox univariate and multivariate regression analyses were conducted to evaluate the impact of various clinical characteristics on prognosis. Results : The metastatic patterns of stage ⅣB pulmonary adenocarcinoma withEGFRmutations was correlated with histopathological growth patterns(P<0.05). In the group with multiple metastases in a single organ, the proportion of micropapillary type in the group with multiple metastases in a single organ was higher than that in the group with multiple-organ metastases(51.1%vs41.1%), while the proportion of solid type in the group with multiple-organ metastases was higher than that in the group with multiple metastases in a single organ(23.8%vs14.2%). Multiple brain or multiple bone metastases were correlated with histopathological growth patterns and tumor differentiation degree. Compared with the multiple bone metastases group, the proportion of acinar type decreases in the multiple brain metastasis group, while the proportion of micropapillary type increased. Moreover, the proportion of poorly differentiated tumors increased significantly(P<0.05). Compared with multiple bone metastases, the proportion of poorly differentiated tumors significantly increases in the group with multiple brain metastases. The median progression-free survival(PFS) of patients with a predominant solid growth pattern was shorter than that of patients with other growth patterns(12.7 monthsvs17.8 months,P<0.05). The PFS of patients in the poorly differentiated group was worse than that in the moderately differentiated group(15.6 monthsvs17.8 months,P<0.05). There were significant differences in PFS among patients with common sensitive mutations and rare mutationsEGFR(17.3 monthsvs10.2 months,P<0.01). Cox proportional hazards regression model suggested that solid growth pattern, poor differentiation and rare single gene mutation were adverse prognostic factors. Conclusion In stage ⅣB pulmonary adenocarcinoma patients withEGFRmutations, both the metastatic patterns and metastatic sites are significantly correlated with the histopathological growth patterns of tumors. Moreover, theEGFRmutation subtypes as well as the histopathological growth patterns and differentiation degree of tumors significantly affect the prognosis of patients.

OBJECTIVE: To observe the anatomical features and relative position of the brachiocephalic trunk and the trachea to provide an anatomical basis for diagnosis and treatment of mechanical airway obstruction and for facilitating the performance of tracheotomy. METHODS: A total of 91 formalin- fixed adult cadavers (70 male and 21 female) were used in this study. The whole length of the larynx and the trachea were separated and exposed from the neck to the chest, followed by separation of the aortic arch and its 3 branches to observe the anatomical position of the brachiocephalic trunk and the trachea. RESULTS: The brachiocephalic trunk and the trachea did not intersect in 3.30%, partially intersected in 71.43%, and completely intersected in 25.27% of the 91 cadaveric specimens. The male specimens all showed greater outer diameter of the aortic arch, the brachiocephalic trunk and the trachea with a greater length of the trachea than the female specimens (P < 0.05), while the distances from the aortic arch to the brachiocephalic trunk or the cricoid cartilage did not differ significantly between them (P > 0.05). The number of the tracheal cartilage rings above the brachiocephalic trunk ranged from 3 to 10, and the mean number did not differ significantly between the male and female specimens (P > 0.05). CONCLUSION The brachiocephalic trunk has complex anatomical relationship with the trachea, and caution should be taken to avoid injuries of the brachiocephalic trunk and the aortic arch in the diagnosis and treatment of mechanical respiratory obstruction and during tracheotomy.
Adult ; Female ; Male ; Humans ; Trachea ; Brachiocephalic Trunk ; Larynx ; Cadaver ; Formaldehyde

Antiviral Agents/pharmacology* ; COVID-19 ; Coronavirus 3C Proteases ; Humans ; Lactams ; Leucine ; Molecular Docking Simulation ; Molecular Dynamics Simulation ; Nitriles ; Proline ; Protease Inhibitors/pharmacology* ; SARS-CoV-2

Objective: To analyze the genotypes, amino acid vatiations and molecular epidemiological characteristics of respiratory syncytial virus (RSV) infection in pediatric patients in Gansu province for the future research. Methods: A total of 4 556 respiratory tract specimens were colleted from pediatric patients under 10 years of age in five cities in Gansu from 2012 to 2017. These specimens were tested for RSV and its subtypes.The coding region of the RSV G gene was amplified using reverse transcription-polymerase chain reaction (RT-PCR) and sequenced for RSV positive specimens. Sequences were edited using DNA Star software. Sequence alignment and phylogenetic trees were built by MEGA 6.0 software. Results: Out of 4 556 specimens, 1 135 (24.91%) were positive for RSV, totally 216 G protein sequences were obtained. RSV A isolates were clustered into three genotypes: NA1、NA3 and ON1. The nucleotides and amino-acid homology was 84.9%-100% and 77.3%-100%, respectively. The nucleotides and amino-acid homology between this study and prototype long strain was 81.2%-83.3% and 74.1%-88.0%. RSV B isolates were clustered into only BA9 one genotypes. The nucleotides and amino-acid homology was 97.7%-100% and 95.8%-100%, respectively. The nucleotides and amino-acid homology between this study and prototype CH18537 strain was 84.9%-85.7% and 77.9%-80.1%. Conclusions The genetic characteristics and the amino-acid changes were analyzed systematically using data of RSV G gene collected from 2012 to 2017 in Gansu province in this study. These data were used for analyses of the etiology, control and prevention of RSV infection.

OBJECTIVE:To establish a method for the content determination of peoniflorin in Danggui shaoyao powder,and provide a reference for controlling the quality of the preparation. METHODS:HPLC was performed on the column of Symmetry C18 with mobile phase of acetonitrile-water(containing 0.1% phosphoric acid)(14∶86,V/V)at a flow rate of 1.0 ml/min,detection wavelength was 230 nm,column temperature was 20℃,and injection volume was 20μl. RESULTS:The linear range of peoniflo-rin was 10-80 μg/ml(r=0.999 3);RSDs of precision,stability and reproducibility tests were lower than 2%;recovery was 98.3%-104.9%(RSD=2.0%,n=9). CONCLUSIONS:The method is simple,accurate and specific,and can be used for the con-tent determination of peoniflorin in Danggui shaoyao powder.

This article gave a detailed account of the practice and characteristics of medical support training in U.S. Navy hospital ship MERCY.We compared the details of medical support training in this ship with those in the Chinese Na-vy hospital ship Ark Peace.We offered suggestions as follows:①During the future medical support training on board, we should regard training procedures and medical techniques as equally important.②We should establish an examination and evaluation team for the medical staff during the training.③We should establish selection standards for significant missions and conduct routine evaluation of the medical staff aboard the hospital ship.

Objective To observe the effect of mifepristone (MIF) on the level of corticotropin releasing hormone (CRH),adrenocorticotropic hormone (ACTH),corticosterone (CORT),insulin (INS) and aldosterone (ALD) in plasma and expression of glucocorticoid receptor (GR) mRNA in hippocampus in type 2 diabetic rats and to discuss the effect and mechanism by which mifepristone improves hyperglycemia. Methods Type 2 diabetes mellitus model was induced by high-fat diet plus intragastric administration of low dose streptozotocin (30 mg·kg-1 ). Rats were randomly divided into normal control group,model control group,positive control (MET) (metformin hydrochloride 200 mg·kg-1 ·d-1 ) group,mifepristone low dose (MIF-L) (10 mg·kg-1 ·d-1 ),medium dose (MIF-M) (25 mg·kg-1 ·d-1 ) and high dose (MIF-H) (50 mg·kg-1 ·d-1 ) groups. The normal control group and model control group were given distilled water. Fasting blood glucose (FBG) was measured once a week. The rats were decapitated after five weeks. Organ index, corticotropin release hormone ( CRH), adrenocorticotropic hormone (ACTH),corticosterone(CORT),insulin(INS) and aldosterone(ALD) levels were measured. The expression of GR mRNA in hippocampus was measured by using real-time PCR. Results Compared with the normal control group, body weight was decreased significantly (P<0. 01),FBG was increased significantly (P<0. 01),organ index was increased significantly (P<0. 05), CRH,ACTH,CORT,INS and ALD were increased and the expression of GR mRNA in hippocampus was decreased (P<0. 01) in the model control group. Compared with model control group,body weight increased in MIF-M and MIF-H groups after administration for 14 days (P<0. 01). FBG was decreased in MIF-M group 1 to 4 weeks after administration,with significant difference (P<0. 05) at 4th week. The kidney index was decreased in MIF-M and MIF-H groups (P<0. 01,P<0. 05). CRH,ACTH and CORT were increased,ALD level was decreased in MIF-L group,CRH,ACTH,CORT and ALD were decreased,INS level was increased in MIF-M and MIF-H groups,without statistically significant differences (P>0. 05). Relative expression of GR mRNA was significantly increased in MIF-L,MIF-M and MIF-H groups (all P <0. 01). Conclusion Hyperglycemia in type 2 diabetic rats can be improved by MIF. The possible mechanism may be related to regulating the HPA axis through inhibiting GR.

Adult ; Female ; Humans ; Lead ; Male ; Middle Aged ; Occupational Exposure ; T-Lymphocyte Subsets ; immunology ; Young Adult

Aim To investigate HPA axis change relation with glucose and lipid metabolism.Methods Wistar rats were injected intraperitoneally with STZ (30 mg·kg~(-1)) after fed with high lipid food for two months, then rats with blood glucose of over 15 mmol·L~(-1) were used in the experiment. Animals were divided into four groups: normal group, diabetic model group, treatment group (ROS 200 mg·kg~(-1) ·d~(-1) ig), and metformin group (200 mg·kg~(-1)·d~(-1) ig).Rats were decapitated after they had been administered ig for four weeks and were 24 hour urine collected.Plasma CRH, ACTH, corticosterone, hypothalamic CRH, ACTH of pituitary gland, 24 hour urinary corticosterone and plasma insulin were determined by ELISA and radio immunity kit respectively.Results In diabetic rat model induced by high lipid food and STZ, plasma and urinary glucose level and plasma TC, TG levels were increased, plasma HDL-C and hepatic glycogen content were reduced, which was synchronized with changes of higher pituitary ACTH, plasma and total 24 hour urine corticosterone excretion.Conclusion The disorder of glucose and lipid metabolism of model induced by high lipid food and low dose STZ may be linked to the change of HPA axis.The improvement of ROS on glucose and lipid metabolism in diabetic rats may be linked to the decrease of HPA axis activity.