Metastasis is one of the main causes of death in lung cancer,and tumor microenvironment(TME)disorders promote the formation of Kenang and accelerate lung cancer metastasis.The theory of"Kenang"in TCM is of great significance in explaining the pathogenesis of lung cancer metastasis and guiding clinical treatment.Based on the theory of"Kenang",this article discussed the pathogenesis and treatment of TME disorder in lung cancer metastasis,and analyzed the mechanism of Kenang in the process of lung cancer metastasis based on the pathological mechanism of Kenang formation and its similarity with TME disorder,combined with modern medical research results.The dynamic pathogenesis evolution of"healthy qi deficiency-phlegm-stasis-cancerous toxin"runs through the course of Kenang and lung cancer,and is closely related to the hypoxia,angiogenesis,and inflammatory microenvironment contained in TME disorders.Therefore,this article proposed a hypothesis that TME disorder may be the key to promote the formation of Kenang and accelerate the metastasis of lung cancer.The metastasis of lung cancer should be prevented and treated by the ideas of strengthening the healthy qi and promoting qi circulation,dissolving phlegm and removing stasis,clearing heat and detoxifying,so as to provide a theoretical for the prevention and treatment of lung cancer metastasis by integrated traditional Chinese and Western medicine.

Metastasis is one of the main causes of death in lung cancer,and tumor microenvironment(TME)disorders promote the formation of Kenang and accelerate lung cancer metastasis.The theory of"Kenang"in TCM is of great significance in explaining the pathogenesis of lung cancer metastasis and guiding clinical treatment.Based on the theory of"Kenang",this article discussed the pathogenesis and treatment of TME disorder in lung cancer metastasis,and analyzed the mechanism of Kenang in the process of lung cancer metastasis based on the pathological mechanism of Kenang formation and its similarity with TME disorder,combined with modern medical research results.The dynamic pathogenesis evolution of"healthy qi deficiency-phlegm-stasis-cancerous toxin"runs through the course of Kenang and lung cancer,and is closely related to the hypoxia,angiogenesis,and inflammatory microenvironment contained in TME disorders.Therefore,this article proposed a hypothesis that TME disorder may be the key to promote the formation of Kenang and accelerate the metastasis of lung cancer.The metastasis of lung cancer should be prevented and treated by the ideas of strengthening the healthy qi and promoting qi circulation,dissolving phlegm and removing stasis,clearing heat and detoxifying,so as to provide a theoretical for the prevention and treatment of lung cancer metastasis by integrated traditional Chinese and Western medicine.

Objective To study the effects of concentration of glucose on the proliferation of bone marrow mesenchymal stem cells (BMMSCs).Methods BMMSCs passaged to the 4th to 6th were inoculated and cultured.The control group was treated with DMEM/F12 (1∶1) standard medium,and the basal glucose concentration was 5.5 mmol/L.The experimental group was treated with DMEM/F12 (1∶1) high-glucose medium with the concentration of 20.5,25.5,30.5 and 35.5 mmol/L respectively,and continuously cultured for 15 d.The absorbance (A) values of each group once per day were measured by thiazolyl blue (MTT) colorimetry.Results Compared with the control group,the absorbance was increased at the 2nd,3rd,and 5th days in the 20.5 and 30.5 mmol/L groups,and the differences were statistically significant (all P＜0.05).For the 25.5 mmol/L group,the absorbance was increased at the 2nd,3rd,5th and 8th days,and the differences were statistically significant (all P＜0.05).For the 35.5 mmol/L group,the absorbance was increased at the 2nd,3rd,5th and 8th days and decreased at the 8th day,and the differences were statistically significant (all P＜0.05).The results of 20.5,25.5,30.5 and 35.5 mmol/L groups were further compared one another.The results showed that the absorbance at the 4th and 12th days in the 35.5 mmol/L group were lower than that of the 20.5 mmol/L group,and the differences were statistically significant (all P＜0.05).The absorbance at the 11th and 14th days in the 30.5 and 35.5 mmol/L groups were lower than that of the 20.5 mmol/L group,and the differences were statistically significant (all P＜0.05).Conclusions High-glucose environment can promote the proliferation of BMMSCs in a short time.However,with the prolongation of culture time,this effect is gradually weakened because of the inhibiting effect of high-glucose environment to the cell proliferation.

Objective To establish an influencing factors system for the implementation effect of the vertical integration of services between the hospitals and community health service institutions.Methods Primary data related to influencing indicators were collected by literature review,questionnaire method and in-depth interview,and then the analytic hierarchy process (AHP) and Delphi method were used for the construction of final influencing factors indicator system.Results An influencing factors indicator system which coincides with the status of the vertical integration between hospitals and community health service institutions in Nanjing,Wuhan and Zhenjiang was established,including 4 firstlevel indicators,10 second-level indicators and 36 third-level indicators.Conclusion This study can provide a basis for hospitals and community health centers to improve the integration service system,and fill the gap of research on the influencing factors of the vertical integration of the domestic health care system,which are meaningful for the vertical integration of health care system in other districts and patterns.

Objective Transcutural nursing has been the important part in modern nursing.Developing of the measurement instrument of cultural sensitivity of nursing undergraduates is the basic step in the research of transcultural nursing.Methods On the basis of the composition of cultural sensitivity of the nursing graduates,efforts were undertaken tO develop an instrument to classify cultural sensitivity to different levels through determination of nursing expert panel,and items were selected by trials through factor analysis.Results The scale consists of 41 items and includes three domains:cultural awareness.cultural understanding,cultural reaction,education background.The Cronbach's α was 0.849381.Items were selected by trials through factor analysis and the factor load was between 0.398～0.785.Conclusion The good validity and reliability were confirmed.The instrument Can evaluate the cultural sensitivity.