With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Background The widespread use of herbicides has led to environmental contamination and has implications for human health. The liver is an important organ for the detoxification of environmental pollutants; however, studies on the association between herbicide exposure and liver function are limited. Objectives To investigate the association between baseline serum herbicide levels and changes in liver enzyme levels and liver enzyme abnormalities over a 5-year period in middle-aged and older adults. Methods This study was based on a nested case-control population of type 2 diabetes established in the Dongfeng-Tongji cohort, with a total of 1388 subjects included in this study and followed up for 5 years. Epidemiological data were collected through questionnaires, and baseline serum concentrations of three herbicides (metolachlor, propham, and acetochlor) were measured by gas chromatography-triple quadrupole mass spectrometry. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were detected at baseline and follow-up visits. The associations between baseline serum herbicide levels and changes in AST and ALT over 5 years were assessed using linear regression models with herbicide levels categorized into quartiles, adjusting for age, sex, education level, smoking status, drinking status, physical activity, body mass index, and new-onset type 2 diabetes occurred during follow-up. The relationship between baseline serum herbicide levels and the risk of liver enzyme abnormalities during follow-up was further analyzed using logistic regression models. Results The positive rates of metolachlor, propham, and acetochlor were all higher than 80%, and their spiked rates of recovery ranged from 73.46% to 106.77%. The mean ± standard deviation of the age of subjects at baseline was (62.7±7.6) years, with 34.1% being male. The median serum levels of metolachlor, propham, and acetochlor at baseline were 0.05, 0.16, and 0.03 ng·mL⁻¹, respectively. There was no significant difference in baseline serum herbicide levels between the normal and abnormal liver enzyme groups at follow-up (P >0.05). The baseline liver enzyme levels and the changes in AST and ALT over 5 years in those who developed abnormal liver enzymes were significantly higher than those in the normal liver enzyme group (P <0.05). The linear regression analysis showed that the changes in AST increased progressively over 5 years in the second, third, and fourth quartiles of propham compared to the lowest quartile group (the second quartile: b=1.49, 95%CI: 0.10, 2.87; the third quartile: b=1.52, 95%CI: 0.14, 2.90; the fourth quartile: b=1.69, 95%CI: 0.31, 3.08; P <0.05). The associations of serum metolachlor and acetochlor with changes in AST were not significant. Additionally, no significant relationships were found between the three serum herbicides and the changes in ALT over 5 years or the risk of liver enzyme abnormalities. Conclusion Serum propham levels in middle-aged and older adults are positively associated with changes in liver enzyme AST, which may have an effect on liver function. More studies are needed to provide scientific evidence for the association between herbicide exposure and liver function.

Objective:To evaluate the influence of ankle acupuncture on the cognitive impairment caused by sevoflurane in elderly rats and the expression of hippocampal phosphorylated phospholipase Cγ (p-PLCγ).Methods:Fifteen SPF-grade healthy male Sprague-Dawley rats, aged 18 months, weighing 530-600 g, were allocated into 3 groups ( n=5 each) using a random number table method: sham surgery group (S group), cognitive dysfunction group (CD group) and ankle acupuncture group (A group). The cognitive dysfunction model was prepared by inhaling the mixture of 3% sevoflurane and air, with ankle acupuncture applied to the right hind limb 1-3 region for 30 min prior to anesthesia in A group. S group received sham stimulation. Two days later, the cognitive function was assessed using the Morris water maze test. The rats were subsequently sacrificed and hippocampal tissues were collected for microscopic examination of the pathological changes (using HE staining and Nissl staining) and for determination of the expression of p-PLCγ, phosphorylated calcium/calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ) and phosphorylated inositol-1, 4, 5-trisphosphate receptor (p-IP3R). Results:Compared with S group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, and the expression of p-PLCγ, p-CaMKII and p-IP3R was up-regulated in CD group and A group ( P<0.05). Compared with CD group, the escape latency was significantly shortened, the number of crossing the original platform quadrant was increased, and the expression of p-PLCγ, p-CaMKII and p-IP3R was down-regulated in A group ( P<0.05). The pathological changes were significantly reduced in A group compared with CD group. Conclusions:Ankle acupuncture can ameliorate cognitive dysfunction induced by sevoflurane in elderly rats, and the mechanism is related to inhibition of hippocampal p-PLCγ expression.

Objective Tostudy the influence of pipe structures on the mixing uniformity of airborne effluents from nuclear power plant chimneys. Methods We used the computational fluid dynamics (CFD) method to simulate the velocity distribution and gas mixing in long straight pipes (I type) with square section and circular section, 90° single-bend pipes (L type) with square section and circular section, and 90° double-bend pipes (S type and U type) with square section and circular section. Results For the long straight pipe, due to the lack of flow disturbance caused by structural changes, the mixing effect was not good; when the pipe section was circular, it might take mixing distance 20 times the hydraulic diameter to achieve the uniformity index required by the relevant standard; for the square pipe, the distance might be longer. In the single bend pipe with square section, the velocity uniformity was improved more greatly after the bend, and the tracer gas met the mixing uniformity at a shorter distance (11 times the hydraulic diameter), as compared with the single bend pipe with circular section. For the S-type double-bend pipe, the tracer gas appeared uniformly mixed after a distance 6 times the hydraulic diameter in the square pipe, and 7 times the hydraulic diameter in the circular pipe. For the U-type double-bend pipe, the gas in the square pipe also achieved uniform mixing ata shorter distance downstream, and the airflow showed greater disturbance when passing through the bend. Conclusion The CFD method can make an accurate prediction for the change patterns of gas mixing uniformity in pipes with different structures, and can partially replace physical experiments to study the factors affecting the mixing uniformity of airborne effluents from the chimney of nuclear power plants.

Because of the complex buildings, the wind flow and the pollution diffusion will be affected in the microscale such as urban neighborhood or the site of facility, the straight Gaussian plume model will not be available. Based on the Reynolds-Averaged Naiver-Stokes(RANS) method which was used to calculate the wind field with the Lagrange particle random walking model, the radioactive pollution diffusion model and microscale radiation environmental impact assessment software system were developed. This system can be used in the factory or city streets and other similar conditions for simulating radioactive pollutants diffusion behavior. The development of the system will provide technical tools for the microscale radiation environmental impact assessment in the future.

Objective:To investigate the advantages and disadvantages of percutaneous compression plate (PCCP) for femoral neck fractures in the elderly patients.Methods:A retrospective study was conducted of the 31 elderly patients with femoral neck fracture who had been treated with PCCP from January 2012 to December 2018 at Orthopaedic Department, The First People's Hospital of Yancheng, Orthopaedic Department, The Ninth People's Hospital of Wuxi and Department of Orthopaedics, The People's Hospital of Wuxi. They were 16 men and 15 women, aged from 65 to 80 years (average, 70.5 years). By the Garden classification, 7 cases were type Ⅱ, 15 cases type Ⅲ and 9 cases type Ⅳ; by the Singh index, 4 cases were level Ⅲ, 11 cases level Ⅳ, 10 cases level Ⅴ and 6 cases level Ⅵ. The time from injury to operation ranged from 3 to 14 days (average, 5.8 days). The operation time, intraoperative blood loss, fracture reduction, fracture union time, complications and functional recovery of the hip were observed.Results:The operation time averaged 73.4 min and intraoperative blood loss 116.4 mL. At one week after operation, the Garden alignment index was level Ⅰ in 25 cases and level Ⅱ in 6. Superficial incision infection was noted in one case intraoperatively. Follow-ups for the 31 patients ranged from 12 to 47 months (mean, 18.9 months). All the fractures united after 4.9 months on average (from 4 to 8 months). Delayed union occurred in 2 cases, neck shortening in 12 cases, and avascular necrosis of femoral head in 3 displaced subcranial fractures 2 of which were high shear ones. The necrosis of femoral head was treated by arthroplasty in 2 and by conservative treatment in one. The Harris hip scores at the last follow-up for the 31 patients averaged 90.9 (from 75 to 100), giving 15 excellent, 12 good and 4 fair cases and an excellent to good rate of 87.1% (27/31).Conclusions:In treatment of femoral neck fractures in the elderly patients, PCCP has advantages of allowing early weight-bearing after operation, a high rate of fracture union, limited complications and quick and fine functional recovery of the hip. However, it should be used with caution in patients with severe osteoporosis, displaced subcranial or high shear fracture.

【Objective】 To retrospectively analyze the key performance indicators of two hepatitis B surface antigen (HBsAg) ELISA reagents used in blood stations, so as to provide basis for reagent selection from the perspective of laboratory performance. 【Methods】 The test results, reactive rate of initial/repeat test, concordance rate of initial and repeat test, and the NAT-yield implicated in ELISA-reactive samples with one assay from 2016 to 2019 were analyzed to compare the detection performance of two ELISA reagents. 【Results】 The total ELISA reactive rate of HBsAg was 0.39%(1 863/480 741), with 0.31% and 0.29% in two reagents, respectively. The initial reactive rate were 0.44% and 0.39%, concordance rate of initial and repeat test was 70.21% and 74.55%, respectively. 43 NAT-yield samples were implicated in ELISA-reactive samples with one assay. 【Conclusion】 There are differences underlying in the detection performance of the two reagents. In order to avoid blood waste and ensure blood safety, the key performance indexes and test results should be taken into consideration when selecting reagents.

Objective To investigate the correlation of the expression of microRNA-424-5p (miR-424-5p) and orthodenticle homeobox 1 (OTX1) gene in colorectal cancer (CRC) tissue,and the effects of miR-424-5p on the proliferation,migration and invasion of CRC cells HCT116.Methods A total of 60 patients with CRC were collected from June 2017 to June 2018 in Department of Colorectal Surgery of Third Affiliated Hospital of Kunming Medical University.Real time quantitative PCR (RT-qPCR) was used to detect the expression of miR-424-5p and OTX1 mRNA in 60 cases of CRC tissues,para-carcinoma tissues and CRC cell lines.The correlation between the expression of miR-424-5p and OTX1 gene was further analyzed.miR-NC (miR-NC group) and miR-424-5p-mimic (miR-424-5p-mimic group) were transfected into HCT116 cells.CCK-8 assay,scratch assay and Transwell assay were used to detect the effects of miR-424-5p on the proliferation,migration and invasion of HCT116 cells.The effect of miR-424-5p on the expression of OTX1 protein was detected by Western blotting.The luciferase report assay was used to detect the influence of miR-424-5p on the luciferase activity of OTX1-3'UTR vector.Results The relative expressions of OTX1 mRNA in CRC tissues and para-carcinoma tissues were 1.049 ±0.446 and 0.639 ±0.178 (t =-6.583,P ＜0.001);and the relative expression of miR-424-5p in CRC tissues and para-carcinoma tissues were 0.865 ± 0.261 and 1.329 ± 0.387 (t =7.705,P ＜ 0.001),with statistically significant differences.Negative correlation was found between the expression of miR-424-5p and OTX1 mRNA in CRC tissues (r =-0.439,P =0.015).The absorbance values of HCT116 cells transfected with miR-424-5p-mimic were 0.813 ± 0.064,0.960 ± 0.098,1.287 ± 0.192 on 72,96 and 120 hours respectively,and those of HCT116 cells transfected with miR-NC were 1.163 ±0.158,1.645 ±0.117 and 2.043 ±0.236.The proliferation ability of miR-424-5p-mimic group was lower than that of miR-NC group and the differences between the two groups were statistically significant (t =3.538,P =0.024;t =7.778,P =0.001;t =4.257,P =0.013).The scratch assay showed that the migration of HCT116 cells in miR-424-5p-mimic group was inhibited as compared with miR-NC group.The numbers of cells permeating septum of miR-NC and miR-424-5p-mimic group were 177.104 ± 17.834 and 35.667 ± 13.634,and the difference was statistically significant (t =15.246,P ＜ 0.001).The relative expressions of OTX1 protein in miR-NC and miR-424-5p-mimic group were 0.862 ±0.121 and 0.342 ±0.103 respectively,and the difference was statistically significant (t =16.286,P ＜ 0.001).Luciferase report assay showed that the luciferase activities of wt-OTX1-3'UTR and mut-OTX1-3'UTR vector were 0.305 ± 0.095 and 0.898 ± 0.080 after over expression of miR-424-5p,and the difference was statistically significant (P ＜ 0.001).Conclusion The expressions of miR-424-5p and OTX1 mRNA are negatively correlated in CRC tissue.miR-424-5p can inhibit the proliferation,migration and invasion of CRC cells by down-regulating the expression of OTX1.

OBJECTIVE: To compare the application among intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy(3D-CRT) and conventional radiotherapy (CRT) for locally advanced middle-low rectal cancer. METHODS: From January 2015 to December 2016, 93 locally advanced middle-low rectal cancer patients with clinical stage cT3N+M0 or cT4N0/+M0 who underwent preoperative concurrent chemoradiotherapy at Department of Colorectal Surgery, the Third Affiliated Hospital of Kunming Medical University and had complete data were enrolled in this retrospective cohort study. Patients were divided into IMRT group (17 cases), 3D-CRT group (28 cases) and CRT group (48 cases) according to different radiotherapy methods. The frequency and dose of CRT were 1 time/day, 5 times/week, for a total of 5 weeks, with a single dose of 2.0 Gy, the total dose was 50 Gy. Frequency and dose of 3D-CRT and IMRT were 1 time/day, 5 times/week, for a total of 23 to 28 times, with a single dose of 1.8 to 2.0 Gy, and a total dose of 45.0 to 50.4 Gy. The chemotherapy regimen was performed with capecitabine tablets at a dose of 825 mg/m twice a day for 5 days every week, at the same time during radiotherapy. The efficacy, chemotherapy adverse reactions and immune function of the three groups were compared. RESULTS: There was no significant difference in the baseline data among the three groups (all P>0.05). The proportion of patients receiving permanent ostomy in the IMRT group and the 3D-CRT group was 29.4%(5/17) and 32.1%(9/28) respectively, which was lower than 58.3%(28/48) in CRT group, and the difference was statistically significant (χ²=7.982, P=0.030), while this proportion was not significantly different between IMRT and 3D-CRT group(χ²=0.037, P=0.848). The pathologic complete response(pCR) rate was 23.7%(22/93) in the whole study, and the pCR rate was 39.3%(11/28) in the 3D-CRT group, which was higher than that of CRT group and IMRT group [12.5%(6/48) and 29.4%(5/17)], and the difference was statistically significant (χ²=7.407, P=0.025), while there was no significant difference in pCR rate between CRT group and IMRT group (χ²=2.554, P=0.110). There was no adverse reaction of grade 3 or above in all three groups. No significant difference in the incidence of bone marrow suppression, abnormal liver and kidney function markers, digestive tract reaction or radiation dermatitis was found(all P>0.05). After receiving concurrent chemoradiotherapy, the proportion of CD3/CD4 cells in the IMRT group and the CRT group decreased compared with that before treatment(23.1±9.3 vs. 31.1±10.9, 27.4±10.7 vs. 33.6±7.2, respectively); the proportion of CD3/CD8 cells was up-regulated (36.1±15.2 vs. 24.8±10.9, 30.9±14.4 vs. 24.0±8.3,respectively), and the differences were statistically significant (both P<0.05), while the above indexes before and after treatment were not significantly different in the 3D-CRT group(all P>0.05). After treatment, the proportion of CD4/CD8 cells in IMRT group decreased (0.8±0.6 vs. 1.6±1.0, t=3.838, P=0.003), while this proportion was not significantly different in CRT group and 3D-CRT group(all P>0.05). CONCLUSIONS IMRT and 3D-CRT can reduce the rate of permanent stoma. 3D-CRT can increase pCR rate. No obvious advantage is shown in IMRT as compared with 3D-CRT in the short-term efficacy. On the contrary, an immunosuppressive status may occur. Therefore, 3D-CRT is recommended as the best preoperative treatment strategy for patients with locally advanced middle-low rectal cancer, especially for those with immunosuppression status.
Humans ; Radiotherapy ; methods ; standards ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; standards ; Radiotherapy, Intensity-Modulated ; standards ; Rectal Neoplasms ; radiotherapy ; Retrospective Studies

Objective To develop the Chinese version of the nasal obstruction symptom evaluation (NOSE) questionnaire.Methods After introduction,forward and backward translation,synthesis,expert committee review,pretest,adaptation and validation followed the international guidelines,the Chinese version of NOSE scale was tested among 223 nasal septal deviation patients and 80 health volunteers to further assess its psychometric and clinical properties.SPSS 19.0 software was used to analyze the data.Results The Chinese version demonstrated satisfactory evaluation results.The acceptance rate of the questionnaire was 97.6％ and 94.1％ in the patient group and control group respectively,and the completion time was (1.5 ± 0.5) min and (1.0 ± 0.5) min.Internal consistency reliability (Cronbach' s α) was calculated to be 0.869.Test-retest reliability coefficient was adequate at rs =0.996.Content validity was approved by our expert committee.Criteria validity (Spearman correlation coefficient) between NOSE Chinese version and SF-36,as well as VAS was-0.837 and 0.725 separately.Construct validity of Chinese version was similar to that of the original edition.The standardized response mean and the effect size at three months postoperatively was respectively 1.34 and 1.21,indicating high responsiveness.Calculated by Mann-Whitney U test,the instrument showed excellent sensitivity to discriminate the subjects with or without nasal obstruction (P ＜ O.01).The NOSE scores were also correlated with nasal resistance by rhinomanometry.Conclusions The NOSE Chinese version was successfully cross-cultural adapted and validated.It therefore can be recommended as a robust tool for future measuring subjective severity of nasal obstruction in China.