Objective To observe the value of spectral CT multi-parameter imaging for preoperative predicting lymph node metastasis(LNM)of gastric cancer.Methods Totally 136 patients with gastric adenocarcinoma were retrospectively enrolled.The patients were further divided into LNM group(n=74)and non-LNM group(n=62)according to postoperative pathological findings of lymph nodes status.Clinical data,conventional CT findings and spectral CT parameters were compared between groups.Factors being significant different between groups were included in multivariate logistic regression analysis to screen independent predictors of gastric cancer LNM.Clinical+conventional CT model(model 1),spectrum CT model(model 2)and combined model(model 3)were constructed based on the above independent predictors,respectively.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for preoperative predicting LNM of gastric cancer.Results CT-N stage,CT-T stage,70,100 and 140 keV CT valuestumor at arterial phase(AP),arterial enhancement fraction(AEF)and normalized iodine concentration at venous phase(NICVP)were all independent predictors of gastric cancer LNM(all P＜0.05).AUC of model 3 was 0.846,higher than that of model 1 and model 2(AUC=0.767,0.774,Z=-0.368,-2.373,both P＜0.05)for preoperative predicting LNM of gastric cancer,while the latter two were not significantly different(Z=-0.152,P=0.879).Conclusion Spectral CT multi-parameter imaging could effectively predict LNM of gastric cancer preoperatively.

ObjectiveTo investigate reinfection or the third time infection with SARS-CoV-2 among the people tested for positive from December 2022 to January 2023 and the influencing factors through a follow-up survey on previous novel coronavirus nucleic acid positive individuals between March to May, 2022. MethodsEpidemiological data of 2 583 novel coronavirus nucleic acid test positive cases were analyzed from March to May, 2022, following a follow-up survey at the 8^th and 12^th month after the first nucleic acid test positivity. Pearson chi-square method was used to analyze the differences of reinfection and the third time infection rates among first-positive patients with different characteristics. Kaplan-Meier survival analysis and Cox regression were used to analyze the influencing factors of reinfection. ResultsA total of 2 264 valid questionnaires were collected in the 8^th month after nucleic acid tested positive, with a recovery rate of 87.7% and a reinfection rate of 9.7%. The third time infection was investigated among the individuals infected twice at the 12^th month after the first nucleic acid test positivity, with a third time infection rate of 4.6%. The median interval (P₂₅, P₇₅) between reinfection and the first nucleic acid test positive for the novel coronavirus was 261 (252, 268) days and the interval (P₂₅, P₇₅) between the third time infection and reinfection was 135 (111,157) days. Gender, age, occupation, smoking, drinking and underlying diseases were not statistically associated with the risk of reinfection (P>0.05). However, the the third time infection rate for medical staffs (20.0%) was higher than that for student /teachers (14.3%) and corporate employees (9.5%), with a statistically significant difference in the third infection rate between different occupations (P<0.05). The risk of reinfection in self-employed individual was lower than that in corporate employees (HR=0.52, 95%CI: 0.33‒0.83), and which was still lower after adjustment for gender and age. The risk of reinfection among those with underlying diseases was 1.54 times (95%CI: 1.08‒2.02) higher than those without underlying diseases, but even 1.85 times (95%CI: 1.25‒2.75) higher after adjustment for gender and age. ConclusionDue to the constant mutation and variants of the novel coronavirus, the risk of reinfection and the third time infection is unavoidable. The presence of underlying diseases and occupation are the main factors influencing reinfection or third time infection.

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.

OBJECTIVETo evaluate the pain severity, the motor function of the upper limb and the quality of life in the patients of post-stroke shoulder pain treated with the touching-periosteum needling technique of the meridian muscle region theory.

METHODSOne hundred and six cases of post-stroke shoulder pain were randomized into an observation group and a control group, 53 cases in each one. In the observation group, the touching-periosteum needle technique and the rehabilitation training were used on the bases of the theory of meridian muscle region. The points were,,,, Quchi (LI 11), Shousanli (LI 10) and Waiguan (TE 5) on the affected side. The needles were inserted obliquely, at 45°degrees at those extra points to the tendon knots till the needle tips touching periosteum. The needles were manipulated to ensure thearrival and then retained for 30 min. The rehabilitation was applied, such as the anti-spasmodic posture, bridge-style movement on the bed, weight transition and balance training, joint activity maintenance training, passive and active movement of shoulder joint, the training for activities of daily living (ADL) and Bobath technique. In the control group, the routine acupuncture and the rehabilitation training were used. The acupints were Jianyu (LI 15), Binao (LI 14), Jianliao (TE 14), Jianqian (Extra), Quchi (LI 11), Shousanli (LI 10) and Waiguan (TE 5). The rehabilitation training was the same as the observation group. The treatment was given once every day, 6 treatments a week. After 20 treatments, the visual analogue scale (VAS), Fugl-Meyer (FMA) score and Barthel (MBI) score were adopted to evaluate the pain severity, the motor function of the upper limb and the ADL. The clinical therapeutic effects were evaluated in the two groups.

RESULTSThe VAS scores were reduced after treatment as compared with those before treatment in the two groups, and FMA and MBI scores were all increased as compared with those before treatment, indicating the significant difference statistically (<0.05,<0.01). After treatment, the improvements in the observation group were better than those in the control group (all<0.05). The curative and remarkably effective rate was 69.8% (37/53) in the observation group, better than 47.2% (25/53) in the control group (<0.05).

CONCLUSIONThe touching-periosteum needling technique of the meridian muscle region theory obviously improves the pain severity, the motor function of the upper limb and the quality of life in patients of post-stroke shoulder pain. The therapeutic effects are better than the routine acupuncture.

Objective To evaluate the efficacy and safety of 13-cis retinoid acid (13-CRA) and all trans retinoid acid (ATAR) redifferentiation therapy in patients with poorly differentiated thyroid cancer. Methods A single-center, randomized, double-blind, parallel controlled clinical trial was preformed. All patients were randomized into three groups. 78 cases were enrolled in each group. The patients were treated by 13-CRA in A group, by ATRA in B group, and by placebo in control group. The induced effects of retinoid acid (RA) and 131I treatment efficacies were defined as primary outcome of efficacy. Results After RA induction therapy, the effective rates in A, B, and control groups were 59.72%, 52.86% and 7.69%, respectively, with statistically significant difference among 3 groups (P<0.05). Compared with control group, A and B groups revealed significant induced efficacies (P<0.017), but there was no significant difference between A group and B group. After 131I treatment, the effective rates in A, B, and control group were 70.83%, 64.29%, and 28.21% respectively, with statistically significant difference (P<0.05). Compared with control group, the effective rates of 131I treatment in A and B groups were significantly raised (P<0.017), but there was no significant difference between A group and B group. The damage of skins and mucous membranes such as desquamation, dry skin, dry lips, dry eyes, etc occurred mostly in A group. The symptoms of nervous system such as headache, dizziness, etc occurred mostly in B group. Conclusions The induced differentiation of 13-CRA or ATRA is an effective method for the treatment of poorly differentiated thyroid carcinoma.

Objective To investigate the effect of dihydromyricetin on proliferation and apoptosis of breast cancer MCF-7 cells.Methods From March 2014 to February 2015,breast cancer MCF-7 cells were treated with 99% pure DMY as an inhibitor.MTT assay,flow cytometry and immunocytochemistry were used to analyze the proliferation,apoptosis and protein expression of breast cancer cell MCF-7.Results When the DMY concentration was higher than 20 μg/mL,the inhibitory effect appeared,but not good.When 40 and 80 μg/mL DMY were used,the proliferation of MCF-6 cells were significantly inhibited,and have different degrees of sensitivity to it.When DMY was 80 μg/mL,the IC50 was 226.9 μg/mL.The inhibition rate and IC50 were compared with 0 μg/mL DMY,there was significant difference(P<0.05).Indicating that the relatively high concentration of DMY could significantly improve the patient′s condition of breast cancer;MCF-6 cells treated with 40 and 80 μg/mL DMY could induce G2/M phase arrest in DMY with concentration greater than 20 μg/mL(P<0.01),and showed significant cell apoptosis death phenomenon.At the same time,G0/G1 phase was also blocked and S phase cells decreased significantly,the difference was significant(P<0.05).The positive rate of PCNA in breast cancer MCF-6 cells significantly decreased(P<0.01) when the DMY concentration was higher than 50 μg/mL,the positive rate was> 50%,especially in DMY with 80 μg/mL,the positive rate was 10.00%.Compared with 0 μg/mL DMY,the difference was significant(P<0.05).Conclusion The use of dihydromyricetin in breast cancer patients can effectively inhibit the rapid increase of cancer cells,accelerate apoptosis,slow down the patient′s condition,the effect is outstanding.

Objective To explore the mediating role of self-confidence in the parental rearing style and facing-audience com munication apprehension(FACA).Methods The Chinese College Students' Facing-audience Communication Apprehension Scale (revised version of 2011),the Short-form Egna Minnen av Barndoms Uppfostran for Chinese(s-EMBU-C) and the Overall Self-confidence Questionnaire Version of College Students were adopted to survey on 1 072 college freshmen from Guizhou Province.Results FACA in the freshmen of non-one-child was significantly higher than that in the freshmen of one-child,FACA in the freshmen of good performance was significantly lower than that in the freshmen of middle and poor performance;FACA of college freshmen,parental rearing style and self-confidence were significantly correlated with each other;self-confidence played a complete mediated role between the parental care and FACA,and a partial mediated role between the parental control and FACA.Conclusion Self-confidence has significant mediate effect between the parental rearing style and FACA of college freshmen.

Objective To explore the effects of combination of capecitabine and docetaxel for the treatment on advanced breast cancer and their influence on tumor biomarkers.Methods The 75 cases with advanced breast cancer were randomly recruited from December 2010 to December 2015 in our hospital,and they were divided into the observation group (38 cases) and control group (37 cases) according to the admission time,the patients in control group were treated with docetaxel,while patients in the observation group were treated with combination of capecitabine and docetaxel,the clinical efficacy before and after treatment was observed,and the changes of serum CEA,glucose CA125,CA15-3 and adverse reaction were compared between two groups.Results The effective rate (RR) of the control group was 40.54% (15/37),and the disease control rate (DCR) was 67.57% (25/37).The RR was 63.16% (24/38) and DCR was 86.84% (33/38)in the observation group.There was significant difference between the two groups (P<0.05).No statistically significant difference was observed between the two groups on the the levels of serum tumor biomarker,CEA,CA125 and CA15-3 before treatment (P>0.05);After treatment,the levels of CEA,CA125 and CA15-3 in both two groups were significantly lower than those before treatment (P<0.05);Moreover,after treatment,the observation group of three tumor biomarkers were significantly lower than those of the control group (P<0.05).Conclusion Combination of capecitabine and docetaxel in the treatment of advanced breast cancer can reduce the serum tumor biomarkers significantly,attenuate the side effects,and the patients are in the good tolerance,it can be widely recommended in clinical use.

The paper described the professional approach of Shanghai Hospital Development Center(SHDC)in developing a professional team of public hospital directors by such means as operation and management-autonomy,fixed tenures system,performance appraisal,part-time job control and income distribution. Recommendations raised include an organic unity of management functions of investors and power of management of the directors to motivate them in their management;building a comprehensive investor management system and strict cadre management mechanism to enhance supervision of the directors.

Objective To provide a more accurate calculation method for design of condensing heat exchanger (CHX) through an in depth discussion about working conditions of the CHX commonly used in temperature and humidity control system of manned spacecraft.Methods With difference of the simplified configuration of CHX,a mathematical model was given.Specifically,the log-mean temperature difference (LMTD) method was used in dry conditions,while in wet conditions mass and energy conservation equations were used.The set of equations of the model were solved by using the shooting method provided by Matlab/Simulink program.Results The results of working conditions and the performance of heat transfer and dehumidification of CHX were determined.Analysis showed that the simulation model could evaluate performance of the CHX in different work conditions reasonably and the results were close to the physical phenomenon.Conclusion The simulation models are of significance for design and optimization of CHX both in manned spacecraft temperature and humidity control system and in aircraft environmental control system.