Purpose To investigate the clinicopathological characteristics and genetic variations of stage Ⅰ lung adenocarci-noma with high-grade components,according to the new grading system of the WHO classification of thoracic tumors(2021).Methods A retrospective analysis was conducted on the clini-cal data of 785 patients with stage Ⅰ lung adenocarcinoma.HE,EnVision immunohistochemistry and Victoria blue staining were used,common genetic variation(EGFR/KRAS/ALK/ROS1/RET)were detected by PCR method.The correlation between different high-grade components and clinical pathological charac-teristics as well as genetic variations in stage Ⅰ lung adenocarci-noma were analyzed.Results A total of 785 cases of stage Ⅰlung adenocarcinoma were enrolled,including 332 cases with high-grade components and 453 cases without high-grade compo-nents.Among the adenocarcinomas with high-grade components,there were 7 cases of grade 1,150 cases of grade 2,and 175 ca-ses of grade 3.The positive rates of tumor cells spreading through airspace(STAS),vascular invasion,and pleural inva-sion in grade 2 adenocarcinoma with two high-grade components(61.5％,21.2％,26.9％)were significantly higher than that of the adenocarcinomas with only one high-grade component(20.4％,7.1％,5.1％),but there was no significant differ-ence in grade 3 adenocarcinoma.The positive rate(39.0％)of STAS in the micropapillary group with one high-grade component in grade 2 adenocarcinoma was significantly higher than that in the complex glandular group(9.3％)and the solid group(0),while there was no significant difference between the latter two groups.Among the three groups there were no statistically signif-icant differences in grade 3 adenocarcinoma.In 167 cases of ad-enocarcinoma with two or more high-grade components,there were 74 cases(44.3％)of complex glands combined with mi-cropapillary components,67 cases(40.1％)of complex glands combined with solid components,8 cases(4.8％)of micropap-illary combined with solid components,and 18 cases(10.8％)of three types of components.The positive rates of pleural inva-sion and KRAS gene mutation or fusion gene(ALK/ROS1/RET)in the group of complex glands combined with solid(49.3％,28.3％)were significantly higher as compared to those in the group of complex glands combined with micropapil-lary(27.0％,8.6％).The positive rate of psammoma bodies in the group with high-grade components(24.7％)was significant-ly higher than that in those without high-grade components(3.5％,P＜0.001),and the positive rate of psammoma bodies in group of gene mutation(EGFR/KRAS)(40.4％)was higher than that in the no-gene mutation group(26.7％,P＜0.05).Conclusion The clinicopathological features of different high-grade components in stage Ⅰ lung adenocarcinoma are not identi-cal,suggesting that their invasiveness may have different biologi-cal backgrounds.Characteristic morphological observations are helpful.

Objective: To investigate an occupational hazardous gas poisoning incident caused by gas leakage in the process of hazardous waste treatment. Methods: An investigation was conducted on a case of occupational acute hazardous gas poisoning caused by waste treatment gas leakage in Shandong province in December 2017. Meanwhile, the clinical data of 5 cases of poisoning patients were analyzed, and the accident related poison test report and other relevant data were analyzed. Results: The incident was caused by the toxic waste did not do labeling work, the workers' protection measures were not in place, the illegal operation and the blind rescue, resulting in a total of 5 people died on the spot, 12 people were hospitalized with poisoning. Among them, 5 patients admitted to our hospital showed varying degrees of damage to the nervous system and respiratory system. After active treatment, they all got better and were discharged. Conclusion The poisoning is mainly caused by hydrogen sulfide dichloromethane hydrogen cyanide gas leakage serious production liability accident, clinical main performance for the nervous system circulatory system respiratory system and other system damage.

Objective: To report a case of rat poison with multiple hemorrhage after trauma. Methods: The clinical data of a case of rodenticide poisoning with hemorrhage as the first symptom admitted to a third-class a hospital in July 2018 were analyzed and summarized. Results: This patient is a rodent drug poisoning patient with hemorrhage as the first symptom.The disease was diagnosed as bromohamelin and bromadiolone poisoning through the analysis of poison detection because the rodent drug was taken in the market and the history of taking poison was concealed. The patient was given active comprehensive treatment of vitamin K1 and other drugs for clinical cure. Conclusion For patients with clinically unexplained hemorrhage, the possibility of rodenticide poisoning should be considered and the toxicant detection should be improved actively.

Objective: To investigate a poisonous mushroom poisoning incident and analyze its clinical data. Methods: Investigate a poisonous mushroom poisoning incident in a place in Shandong in July 2018, at the same time, the clinical data of 2 cases of mushroom poisoning were analyzed and summarized. Results: The incident was caused by a poisoning incident caused by residents eating poisonous mushrooms. The poisonous mushroom in this incident was identified as a scaled white goose cream. Two patients with poisoning developed gastrointestinal symptoms such as nausea and vomiting, abdominal pain and diarrhea, and liver damage occurred later. After active rescue and treatment, one patient was discharged from hospital, and the other patient developed acute pulmonary embolism during the treatment. He was discharged after interventional thrombolysis and follow-up treatment. Conclusion After investigation, the incident was caused by the ingestion of poisonous mushrooms mainly based on the scalloped white goose cream. After active treatment, they were cured and discharged.

Objective To improve the nurses' compliance of elevating the head-of-bed of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation, who had no contraindications of head-of-bed elevation by the installation of angle measuring device and reminding device for head-of-bed elevation, so as to reduce the incidence of ventilator-associated pneumonia (VAP). Methods A total of 575 and 473 cases of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation were selected respectively rom the patients who were hospitalized in Tengzhou Central People's Hospital in Shandong Province in the year of 2014 and 2016. In 2014, before intervention, the implementation of cluster nursing and the general monitoring data of VAP were comprehensively grasped. In 2015, a total of 26 beds in ICU were installed with angle measuring device and reminding device for head-of-bed elevation. In 2016, after intervention, the implementation of cluster nursing and the general information level of the monitoring data of VAP were collected. SPSS 17.0 software was applied for data statistical analysis before and after intervention. Results The nurse compliance of head-of-bed elevation for mechanical ventilation patients was improved after intervention (χ2=1 691.675, P<0.001), as well as the incidence of VAP significantly decreased (χ2=9.248, P=0.002). The incidence of VAP millennium catheterization decreased, but the difference was not statistically significant (χ2=2.694, P=0.058). Conclusions The installation of bed angle measuring device and reminding device can effectively improve nurse compliance of head-of-bed elevation in patients with mechanical ventilation and reduce the incidence of VAP.

Objective To explore the effect of hospital-community-family integrated care on the physical and mental function of discharged stroke patients. Methods Sixty stroke patients discharged from the third people′s hospital of Bengbu were recruited from January 1, 2014 to April 30, 2015. The patients were divided into intervention group and control group by random number table, and 30 patients in each group. Rehabilitated nursing intervention including feeding, language, physical and psychological and psychological trainings were conducted in intervention group, while participants in control group only received routing nursing service. Then, the Barthel index scores, Fugl-Meyer motor function scores and Hanmilton Depression Scale (HAMD) scores were assessed in both two groups pre-intervention and six months after intervention. Results Intervened before and 6 months after the intervention group of patients with Barthel index score respectively (44.17 ± 11.21) points, (72.47 ± 15.36) points, Fugl-Meyer motor function scores were respectively (43.47±16.22) points, (62.39 ±15.41) points, HAMD scores were (26.81 ± 8.24) points, (17.42 ± 6.29). The difference was statistically significant (t=8.16, 4.64, 4.97, P <0.01). In contrast, the control group of patients with Barthel index score changes showed statistical significance (t=1.94, P=0.03), HAMD score also had differences (t=1.86, P=0.04) and the change was far less than the intervention group. Between the two groups after the intervention compared with Barthel index score, Fugl-Meyer motor function score and HAMD also had statistical significance (t=5.81, 3.55, 2.35, P = 0.00). Conclusions The rehabilitated nursing intervention has evident effects onliving environment,daily life, physical and mental function in discharged stroke patients, and the intervention approaches we used have certain clinical practice value.

Objective To detemine the value of cardiac troponin in early diagnosis of severe myocardial contusion in the dog.Methods Twelve dogs weighing (11.4 ± 1.5) kg were subjected to severe myocardial contusion by impacting the chest area with BIM-Ⅱ biological impact machine.Electrocardiogram,cTnT and cTnI were measured before,immediately,and 2,4,6 and 8 hours after injury.Animals were then killed and the serum was separated for gross examination and triphenyl tetrazolium chloride (TTC) staining.Results Supraventricular tachycardia,ventricular tachycardia,ventricular premature beat,myocardial ischemia,atrial fibrillation,and ventricular fibrillation were seen on the electrocardiogram 2,4,6 and 8 hours after the injury,which suggested a high sensitivity but low specificity.cTnT and cTnI levels revealed no specific changes at postoperative 2 and 4 hours,but cTnT and cTnl were significantly increased to (0.130 ± 0.052) ng/ml and (1.615 ± 0.371) ng/ml at postoperative 8 hours,significantly higher than that immediately after operation (P ＜ 0.01).Sensitivity and specificity of cTnT and cTnI were both 100％,while the specificity of the TTC staining was (39.78 ± 9.07)％.Conclusion Cardiac troponin is of high sensitivity and specificity in early diagnosis of severe myocardial contusion and has good correlation with pathological changes,which exhibits great potential in clinical application.

Purpose Two kinds of forward conditional reasoning including modus ponens (MP) and denial of the antecedent (DA) are the most common deductive reasoning in daily life. The present study aimed to explore the difference between the two neural machanisms. Materials and Methods Three kinds of tasks including MP, DA, and baseline were administrated to 14 undergraduates [7 males and 7 females, mean age (23.4±1.3) years] by using functional magnetic resonance imaging (fMRI) technique. fMRI data was analyzed. Results The reaction times were significantly slower for MP and DA than that of BS (P<0.001), while the effect was not significant for accuracy. In contrast to baseline, both MP and DA tasks activated the left inferior frontal cortex (BA 9), inferior parietal lobule (BA 40), and postcentral gyrus. Bilateral caudate significant activation was found in MP task when compared with DA, whereas the frontal, parietal, occipital lobe and anterior cingulate cortex were acivated more in the DA than in MP task. Conclusion Both forward conditional reasoning of MP and DA commonly activate the left frontoparietal cortex, while significant dissociations can be seen in the regions of caudate and bilateral frontal, parietal and occipital. These results firstly demonstrates the different neural mechanism underlying the two forward conditional reasoning, which might help to further uncover the brain mechanism of conditional reasoning.

Objective To study influencing factors in patients with rheumatic diseases.Methods One hundred and twenty patients with rheumatic diseases were selected from November 2013 to February 2014 in our hospital for the study.The influencing factors in patients with rheumatic diseases were obtained by proposed questionnaires,and then the univariate and multivariate Logistic regression analysis were performed to study factors affecting the treatment.Results Patients older than 50 of the observation group accounted for 38％ (18/48),the proportion of farmer,patients with primary school education level or below,and monthly income ＜3 000 RMB was 35％(17/48),60％(29/48),and 46％ (22/48) respectively.Compared with the control group,they were significantly higher than the control group,which were 64％(46/72),58％ (42/72),79％(57/72),65％(47/72) (x2=8.058,P=0.005; x2=6.025,P=0.014; x2=4.986,P=0.226; x2=4.456,P=0.035) respectively.Using the treatment as the dependent variable,age ≥50 years of age,farmer,primary school and lower education level,and monthly income ＜3 000 RMB as the independent variable,we carried out the regression analysis.Age (OR=1.124,95％CI:1.084-7.236),occupation (OR=1.871,95％CI:1.054-7.243),education level (OR=1.982,95％CI:1.157-6.256),monthly income (OR=1.363,95％CI:1.012-8.227) are the influencing factors of rheumatism's treatment.Conclusion The treatment of rheumatic diseases are influenced by many factors,and more societal support should be provided to help patients with rheumatic disease receive professional treatment and better control of the disease.

Objective To observe the expression of Toll-like receptor(TLR) on peripheral blood dendritic cells(DC) in children with Henoch-Schtinlein purpura(HSP),and to investigate the pathogenesis of the abnormal expression of TLR in children with HSP.Methods Twenty hospitalized children with HSP in the Affiliated Hospital of Qingdao University Medical College from Dec.2011 to Jul.2012 were enrolled in the study(HSP group).Twenty agemetched healthy children were selected as a healthy control group.Peripheral venous blood was sampled under aseptic condition,peripheral blood mononuclear cells (PBMC) were isolated from density gradient centrifugation,and DC were generated by recombinat human granulocyte-macrophage colony-stimulating factor(GM-CSF),interleukin-4(IL-4) and tumor necrosis factor-α(TNF-α) in vitro.Expressions of CD83,CD86 and TLR2,TLR3,TLR4 in peripheral blood DC were examined by fluorescent activated cell sorter (FACS).Results 1.No significant distinction was found in the expression of the C Ds3 on peripheral blood DC between HSP group and healthy control group(t =0.80,P ＞ 0.05) ;in HSP group had remarkably increased expression of the CD86 on peripheral blood DC than that of the healthy control group (t =9.56,P ＜ 0.01).2.Expression rates of TLR2,TLR3,TLR4 on peripheral blood DC in the HSP group were higher than those in the healthy control group(t =1 1.79,13.29,9.45,all P ＜ 0.01).3.Expression rates of TLR2,TLR3 and TLR4 in HSP group had positive correlation with expression rates of CD86 (r =0.84,P ＜ 0.01 ; r =0.53,P ＜ 0.05 ; r =0.66,P ＜ 0.05).Conclusions Expressions of TLR2,TLR3 and TLR4 on peripheral blood DC significantly increased and were positively correlated with expression of CD86.This implies that TLR and co-stimulatory molecules might participate in the pathogenesis of HSP by mediating signal transduction,leading to abnormity of cytokines,then inducing Th1/Th2 immune imbalance by showing the advantage of Th2 function.