The red doctor is a spiritual quality gradually molded during the process of the Communist Party of China （CPC） leading China’s healthcare undertakings. Through historical accumulation， the red doctor spirit has become a critical spiritual guide in the field of healthcare in China. The generation of the red doctor spirit is guided by the “spiritual essence” of Marxism， rooted in the “foundational heritage” of China’s excellent traditional medical ethics culture， and nurtured in the “soil” of arduous revolutionary medical practices led by the CPC， embodying the generative logic for the dynamic evolution of theory and practice. Currently， the red doctor spirit demonstrates significant era value in enriching the CPC’s spiritual spectrum， advancing medical talent cultivation， supporting the implementation of the healthy China strategy， and other aspects. In the context of the new era， inheriting the spirit of red medicine requires both expanding its communication channels and integrating it into the ideological and political education of medical schools， achieving a two-way synergy between online and offline platforms.

Perineural invasion (PNI) by tumor cells is a key phenotype of highly-invasive oral squamous cell carcinoma (OSCC). Since Schwann cells (SCs) and fibroblasts maintain the physiological homeostasis of the peripheral nervous system, and we have focused on cancer-associated fibroblasts (CAFs) for decades, it's imperative to elucidate the impact of CAFs on SCs in PNI⁺ OSCCs. We describe a disease progression-driven shift of PNI^- towards PNI⁺ during the progression of early-stage OSCC (31%, n = 125) to late-stage OSCC (53%, n = 97), characterized by abundant CAFs and nerve demyelination. CAFs inhibited SC proliferation/migration and reduced neurotrophic factors and myelin in vitro, and this involved up-regulated ER stress and decreased MAPK signals. Moreover, CAFs also aggravated the paralysis of the hind limb and PNI in vivo. Unexpectedly, leukemia inhibitory factor (LIF) was exclusively expressed on CAFs and up-regulated in metastatic OSCC. The LIF inhibitor EC330 restored CAF-induced SC inactivation. Thus, OSCC-derived CAFs inactivate SCs to aggravate nerve injury and PNI development.
Schwann Cells/metabolism* ; Mouth Neoplasms/metabolism* ; Humans ; Cancer-Associated Fibroblasts/metabolism* ; Animals ; Carcinoma, Squamous Cell/metabolism* ; Neoplasm Invasiveness/pathology* ; Male ; Female ; Mice ; Cell Movement/physiology* ; Cell Proliferation/physiology* ; Cell Line, Tumor ; Leukemia Inhibitory Factor/metabolism* ; Middle Aged

Objective:To discuss the association between occupational acid fog exposure and accelerated biological aging of the workers,and to clarify its related risk factors.Methods:A total of 341 male workers exposed to occupational acid fog and 201 male workers without occupational exposure were selected as the study subjects,and they were divided into exposure group and control group,respectively.The general informations of the subjects in two groups were collected through questionnaires and physical examinations.The levels of red blood cell count(RBC),platelet count(PLT),albumin(ALB),urea(Urea),creatinine(CR),triglycerides(TG),total cholesterol(TC),glycated hemoglobin(HBA1c),and high-sensitivity C-reactive protein(Hs-CRP)in serum of the subjects in two groups were detected.The Klemera-Doubal method(KDM)was used to construct the composite aging measure,KDM-biological age(BA)(KDM-BA).The model parameters were trained using samples from the 2009 China Health and Nutrition Survey(CHNS)Database to calculate the BA acceleration of the subjects in two groups;stratified analysis based on the population characteristics was conducted to analyze the BA of the subjects in two groups with different population characteristics;generalized linear model was used to analyze the factors influencing BA acceleration due to acid fog exposure.Results:The model parameters were trained using samples from the 2009 CHNS Database,including 8 133 cases aged 20-79 years,of which 3 788 were male.The levels of Urea,CR,HBA1c,ALB,and TC,as well as systolic blood pressure(SBP),total working years,sleep duration,and body mass index(BMI)of the subjects between two groups had significant differences(P<0.05).Compared with control group,the BA acceleration of the subjects in exposure group was significantly increased(P<0.05).In entire population and exposure group,the BA acceleration in the smokers was significantly higher than that in the non-smokers(P<0.05).In entire population,control group,and exposure group,the BA accelerations of the subjects in different BMI groups were significantly decreased with the increase of BMI(P<0.05).Compared with control group,the BA acceleration of the subjects in exposure group was significantly increased(P<0.05),including those under 40 years old,with total working years of 4-7 years,Han nationality,unmarried,smokers,and sleep duration 6-7 h,and with overweight.Acid fog exposure,smoking,and BMI were associated with the BA acceleration(β=0.72,95%CI:0.24-1.21;β=0.59,95%CI:0.11-1.06;β=-0.29,95%CI:-0.35—-0.22).Conclusion:Occupational acid fog exposure may accelerate the biological aging in the workers,and acid fog is a risk factor to accelerate the biological aging of the body.

Adenoid cystic carcinoma (ACC) is the second most common pathological subtype of malignant tumors of salivary glands. The incidence of recurrence and metastasis is high after initial treatment. The optimal treatment for these patients is still controversial. In recent years, multiple attempts have been made to treat recurrent and / or metastatic ACC, such as radiation therapy, targeted therapy and immunotherapy. In this article, the treatment options for recurrent and / or metastatic ACC was reviewed and the effect and prospect of each treatment were summarized.

Near-infrared spectroscopy (NIRS) can be employed to monitor regional oxygen saturation (rSO 2), to reflect the oxygen metabolism and local effective blood perfusion of the measured site in a real-time and noninvasive manner.NIRS has been extensively used in monitoring blood perfusion of brain, kidney, gastrointestinal tract and organ function evaluation in different conditions.During the perioperative period of congenital heart disease, hemodynamic fluctuation may easily cause organ hypoperfusion, which would lead to the development of ischemia, hypoxia and internal environment disorder, thus resulting in harmful changes in tissue oxygenation status.However, there is no change in the arterial oxygen saturation (SaO 2) and mixed venous saturation (SvO 2). NIRS can be employed to sensitively monitor the changes of tissue rSO 2, so as to prevent further injury caused by tissue ischemia and hypoxia.This paper briefly describes the basic principle, limitations and new progress of NIRS in the perioperative application of CHD, in order to provide new ideas and directions for its clinical application in the perioperative period of CHD, early evaluate the patient′s condition and guide clinical work.

Objective To explore the scientificity and feasibility of using weighted rank-sum ratio (RSR) method based on diagnosis-related groups ( DRGs) indicators in nursing performance evaluation. Methods Homepage data of medical records were extracted from inpatients discharged in 2017, and " CN-DRGs" burster was used to obtain the DRGs data. Data of medical safety were obtained from the nursing adverse event management system, while data of nursing grading information and medical expenses were obtained from the hospital information system, and the patient satisfaction was obtained in a questionnaire survey. Based on the indicators available, the weighted RSR was applied to evaluate the nursing performance from the 11 dimensions, namely workload, nursing competence, nursing quality, nursing personnel allocation, patient satisfaction, etc. Results The results of the weighted RSR showed that 43, 39, and 6 wards of total 88 wards of the hospital were rated as excellent, medium and poor grades respectively. The results of ANOVA showed that the difference of the 3 grades was significant (F=170. 391, P<0.001). The nursing performance evaluation results were consistent with the actual situation. Conclusions The evaluation of nursing performance with weighted RSR method based on DRGs indicators prove its practical application value, as this method can not only provide data support for nursing personnel allocation, but also provide reference for nursing quality evaluation and supervision.

Objective To investigate the relationship between subgroups of central lymph node metastasis (sCLNM) and lateral lymph node metastasis (LNM) of unilatal papillary thyroid carcinoma (uPTC) with cervical lymph node negative(cN0).Methods The clinical and pathological data of 161 patients with cN0-uPTC who underwent total thyroidectomy+central lymph node dissection+lateral lymph node dissection from Jan.2016 to Dec.2016 were retrospectively analyzed.The relationship between the lymph node metastasis of each subarea in the central area of the affected side and the lymph node metastasis of the affected side was investigated.Results Binary logistic regression analysis of cN0-uPTC subregions in the affected central region showed:pre-laryngeal lymph node metastasis,pre-tracheal lymph node metastasis and paratracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected lateral region(P=0.008,0.016,0.035,respectively).Prelaryngeal lymph node metastasis was an independent risk factor for lymph node metastasis in the affected area Ⅱ (P=0.015).Pre-tracheal lymph node metastasis was an independent risk factor for lymph node metastasis in affected area Ⅲ (P=0.004).Pre-tracheal and para-tracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected Ⅳ area (P=0.035,0.011,respectively).Conclusions The lymph node metastasis pathway of thyroid cancer had certain regularity.The pre-laryngeal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area Ⅱ.The pre-tracheal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area Ⅲ.The pre-tracheal and paratracheal lymph node metastasis have the prediction value for lymph node metastasis of the affected area Ⅳ.Lymph node dissection in affected areas Ⅲ and Ⅳ needs to be considered in patients with pre-tracheal or paratracheal lymph node metastases.On this basis,lymph node dissection on the affected areas Ⅱ,Ⅲ,and Ⅳ might be considered if there is pre-laryngeal lymph node metastasis at the same time.

Objective To improve the canines myocardial infarction curative effect by using ultrasound targeted microbubble destruction (UTMD) combining with nuclear localization signal(NLS) peptide to increase hAng-1 gene transfection efficiency.Methods Forty-six canines were randomly divided into 4 groups (n=10 in each group) after the models of myocardial infarction were prepared.Group A were untreated control;Group B were transfected with hAng-1;Group C were transfected with UTMD+hAng-1;Group D were transfected with UTMD+NLS nuclear localization signal+hAng-1.The therapeutic agents were intravenously injected at one week after myocardial infarction in each group,and the ultrasound were irradiated at the precardium in group C and D.①Echocardiography was used before and at one week after myocardial infarction and 28 days after gene transfection.Two-dimensional echocardiography was used to detect cardiac function,the left ventricular ejection fraction,the left ventricular wall motion and the myocardial contrast echocardiography were used to detect myocardial perfusion of all canines in the four groups.②On twenty-eight days after gene transfection,mRNA and Western Blot were used to detect the expression of hAng-1.Immunohistochemistry was used to detect capillary density of peri-infarct area and microvessel density (MVD).Masson′s trichromatic staining and gross specimen were used to evaluate the degree and the area of myocardial fibrosis.The gene transfection efficiency and the curative effect of all the four groups were evaluated and compared.Results ①Before myocardial infarction,in four groups canine ventricular wall motion and cardiac function were normal,and myocardial filling defect was not showed by myocardial contrast echocardiography.At one week after myocardial infarction,the left ventricular anterior and interval walls motion and the left ventricular ejection fraction in the four groups were significantly decreased.Myocardial contrast echocardiography showed anterior and interval walls myocardial filling defect.There was no significant difference among the four groups(P>0.05);On 28 days after gene transfection the left ventricular ejection fraction in the four group were increased in an order of group A,B,C,D,there was significant difference when comparing group C and D with other groups separately(P<0.05).Myocardial contrast echocardiography showed much contrast filling in the infarction and surrounding area in group D,a little contrast filling in group C and filling defect in group A and group B,there was significant difference when comparing group C and D with other groups separately(P<0.05).②RT-PCR and Western Blot showed the hAng-1 mRNA and protein expression in group D were higher than those in the other group.There was significant difference when comparing group C and group D with other groups separately(P<0.05).③Immunofluorescence showed the capillary densities were(4.7±1.6)/mm2,(11.2±2.8)/mm2,(70.0±6.4)/mm2 and (85.3±7.0)/mm2 in group A,group B,group C and group D.The differences were statistically significant compared group C and group D with other groups (P<0.05).④Masson′s trichromatic staining and cardiac gross specimen showed that the degree and area of myocardial fibrosis were gradually reduced in an order of group A,B,C,D.Conclusions UTMD and NLS peptide could effectively transfect hAng-1 gene and it provided a novel strategy of gene treatment for ischemic heart disease.

Objective:To retrospectively analyze the regularity and risk factors of skip metastasis (central lymph node negative and lat-eral lymph node positive) in papillary thyroid carcinoma (PTC). Methods:A total of 521 PTC patients underwent total thyroidectomy and central plus lateral lymph node dissection at The First Affiliated Hospital of Chongqing Medical University from January 2013 to De-cember 2016. Clinicopathological characteristics of the patients were collected and analyzed. Results:Skip metastasis rate of PTC was 8.3％(43/521). Tumors in the upper lobe (OR=3.401, 95％CI:1.770-6.536;P=0.001) and in the lateral part (OR=3.424, 95％CI:1.182-9.920;P=0.023) of the thyroid, as well as age above 45 (OR=2.856, 95％CI:1.488-5.482;P=0.002), were independent risk factors for skip metastases for this disease. Clinically node-negative (cN0) PTC patients with tumors in the upper lobe had higher possibility of skip metastases than those with clinically involved lateral neck nodes(cN1b) (P=0.022). Conclusion:Skip metastasis of PTC is not un-common. Thus, preoperative clinical assessment and imaging examination for lateral lymph node is necessary, especially for PTC pa-tients who are above 45 years old and with tumors in the upper lobe and/or unilateral area of thyroid. The lateral lymph node dissec-tion should be performed when necessary.

Objective:To analyze the factors related to metastasis of contralateral central lymph node (CLN) in cN0 papillary thyroid car-cinoma (PTC) and discuss the indications for CLN dissection. Methods:We enrolled 149 unilateral PTC patients who underwent total thyroidectomy and prophylactic bilateral (CLN) dissection. This work analyzed the relationship of gender, age, extrathyroidal extension, multifocality, thyroiditis, ipsilateral central lymph nodes, and prelaryngeal lymph node with CLNs. Results:The rates of metastasis to ip-silateral and contralateral central compartments were 73.2%and 23.5%, respectively. In univariate analysis, gender, age, tumor size, multifocality, and thyroiditis were not important in predicting contralateral central compartment lymph node metastasis (P=0.792, 0.097, 0.531, 0.269, and 1.000, respectively);by contrast, extrathyroidal extension (P=0.017), prelaryngeal lymph nodes (P=0.006), and ipsilateral CLNs (P<0.001) are related to CLN metastasis. However, multivariate analysis showed that ipsilateral central metastasis was an independent risk factor for lymph node metastasis in the contralateral central region when the number of ipsilateral central metas-tases is≥3 (P=0.010). Conclusion:Extracapsular invasion, prelaryngeal lymph nodes, and ipsilateral CLN influence the metastases of CLN. Bilateral CLN dissection should be performed when the number of ipsilateral central metastases is≥3 and there is merger of ex-tra-laryngeal lymph nodes or capsule invasion.