The theory of yin and yang is the modest differentiation thought of the traditional Chinese medicine under the guidance of overall dialectics,and the dynamic changes of yin and yang profit and loss can reflect the life activities of the human body.In the early literature research and clinical practice,the author's team found that the"yang deficiency and yin stagnation"is the key pathogen of colorectal cancer,the yang qi is insufficient,and the metabolites of the yin such as phlegm,wetness and stasis are lost in gasification and accumulate to form a"yin tumor",which is stagnant in the intestine and forms colorectal cancer.Yang Qi is the process of normal cell metabolism to produce energy,Yang Qi is insufficient,the"yin knot"of the thing in the body polymerizes into tumors,The imbalance of yin and yang can cause changes in energy or substance metabolism in the body,and glutamine is one of the amino acid which is the largest consumption of tumor cells,and its metabolic process not only provides a material basis for tumor cell growth,but also creates an acidic microenvironment of hypoxia to promote the proliferation and growth of tumor cells.This paper discusses the characteristics of glutamine metabolism of colorectal cancer cells in detail,aiming to explain the occurrence of colorectal cancer from the pathogenesis of"yang deficiency yin knot",and to explain the scientific theory of traditional Chinese medicine in the treatment of coloral cancer with the principle of Wenyang Tongxia,aiming to provide new ideas and methods for the comprehensive treatment of CRC.

Purpose To investigate the clinicopathological and histological features of non-small cell lung cancer(NSCLC)patients with high expression of PD-L1 and positive driver muta-tion.Methods The clinical data of 141 patients with PD-L1 high expression and driver mutation-positive NSCLC were col-lected.Immunohistochemical methods,ARMS-PCR,and next-generation sequencing(NGS)were used to detect PD-L1 ex-pression and driver gene mutations.The clinicopathological fea-tures were analyzed and the related literatures were reviewed.Results There were 141 cases NSCLC patients with high ex-pression of PD-L1 in tumor cells,of which 57 cases were≥50％,＜60％;≥60％,＜70％in 18 cases;≥70％,＜80％in 35 cases;≥80％in 31 cases.Among 141 cases NSCLC patients with high PD-L1 expression,53 cases(37.6％)had driver gene mutations,including 4 cases BRAF 15 exon mutations,9 cases MET-associated mutations,17 cases EGFR-associated mutations,16 cases KRAS 2 exon mutations,4 cases EML4-ALK fusion mutations,and 3 cases other rare mu-tations.The high expression of PD-L1 and the occurrence of driver gene mutation were related to the gender,smoking history and pathological type of patients(P＜0.05).MET-related mu-tations and KRAS 2 exon mutations were more common in males than in females.All BRAF 15 exon mutations were female.The mean percentage of PD-L1 expression was highest in patients with MET mutation,KRAS 2 exon mutation,and 3 cases rare mutations.In 33 cases with BRAF 15 exon mutation,MET am-plification or mutation,EGFR-related mutation,and 3 cases oth-er rare mutations,PD-L1 was highly expressed in solid,glandu-lar,and micropapillary tumor cells.In 20 cases with KRAS 2 exon mutation and EML4-ALK fusion mutation,PD-L1 was highly expressed in solid nested tumor cells.Conclusion In NSCLC,high expression of PD-L1 and positive driver gene mu-tation are negatively correlated with the degree of tumor differen-tiation.In the poorly differentiated surgical specimens of lung adenocarcinoma,solid,micropapillary,or glandular tubular tumor tissues should be selected as far as possible for PD-L1 ex-pression and driver gene mutation detection.

Objective:To realize the accurate prediction of the fall risk of the elderly by a convolutional neural network prediction model.Methods:Stratified random cluster sampling was used from June 2019 to February 2020, Python′s Matlabplot library and Opencv library were used to perform data preprocessing on the plantar pressure data of 1 093 subjects who had come from medical institutionsand community or elderly care institutions of Chongqing and Nanjing, such as data visualization, compression and clipping, grayscale, Gaussian blur, etc., and then the data were divided into training set (983 cases) and verification set (110 cases), the training set data were used to train the convolutional neural network model, the verification set was used to verify the model, and the ReLU function was used to suppress overfitting to obtain the final prediction model.Results:The sensitivity of the fall warning model to the validation set for predicting falls was 91.2%, the specificity was 81.4%, the accuracy was 91.5%, and the AUC was 0.865.Conclusions:The fall prediction model can predict the fall risk of the elderly in a specific scenario. In the subsequent improvement, the software and hardware construction should be comprehensively improved to further improve the prediction accuracy.

Chemotherapy plays an important role in the treatment of lung cancer patients, but it also brings some adverse effects. In recent years, studies from home and abroad have shown that exercise intervention has a good prognosis for lung cancer patients undergoing chemotherapy. This article reviews the role of exercise intervention in the treatment of lung cancer, exercise intervention methods, evaluation indicators of intervention effect and factors affecting the implementation of exercise intervention, and summarizes the implementation and precautions of exercise intervention, so as to provide individualized nursing strategies for patients with lung cancer undergoing chemotherapy and reference for the selection of intervention methods in clinical nursing.

Objective:To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods:Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5- P97.5. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. Results:The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all P<0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all P<0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all P>0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all P<0.05). Conclusions:The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women′s early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women′s early and late pregnancy Fib still need further exploration.

Endosaccular flow diverter is a new endovascular device of treating intracranial wide neck bifurcation aneurysms. Four kinds of endosaccular flow diverters with different shapes and features have been produced and implanted into the intracranial aneurysms. This article provides a review on the features and clinical use of these new devices.

Objective To retrieve,assess and summarize the best evidence on breast milk expression of premature infants' mothers in maternal separation so as to provide high-quality evidence for medical staff to carry out breast feeding guide. Methods Guidelines,systematic reviews,recommended practices and evidence summaries were retrieved in the UpToDate,WHO,Academy of Breastfeeding Medicine(ABM), Cochrane Library,Joanna Briggs Institute Library,Registered Nurses' Association of Ontario(RNAO), National Guideline Clearinghouse(NGC),PubMed,Embase,Chinese Biological Medicine,Chinese National Knowledge Infrastructure,WanFang data,VIP and the evidence-based nursing database of Fudan University from January 2008 to December 2018. Results A total of 7 literatures were included,two guidelines,one clinical decision,two systematic reviews and two evidence summaries. A total of 19 evidences were gathered in 7 aspects,such as training for medical staff,parents' education,selection of breast pump,preparation before expression,operational skills of breast expression,measures for increasing lactation and expression effects monitor. Conclusions Clinical medical staff should lay down the individualized nursing measures for maternal women to ensure breast milk collected as soon as possible,gain enough breast milk and fill the bill of growth and development of premature infants.

Objective To observe the level of imprinting gene p57kip2 and p27kip1 expression in different hydatidiform moles.To investigate the value of combined detection of p57kip2 and p27kip1 in diagnosis and differential diagnosis of hydatidiform moles.Methods We examined the immunohistochemical staining of p57kip2 and p27kip1 in 30 cases of complete hydatidiform moles and 86 cases of partial hydatidiform moles and 30 cases normal placenta,and also analyze the differences and correlation between the two genes of p57kip2 and p27kip1 in two different patterns of hydatidiform moles.Results The rate of expression of p57kip2 and p27kip1 in complete hydatidiform moles was obviously lower than that in partial hydatidiform moles and nor-mal placenta.There were significant differences in the expression of p57kip2 and p27kip1 among complete hy-datidiform moles,partial hydatidiform moles and normal placenta(P<0.05).p57kip2 had positive correlation with p27kip1 in complete hydatidiform moles(r=0.750,P<0.01),meanwhile there was negative correlation between p57kip2 and p27kip1 in partial hydatidiform moles(r= -1.000,P<0.01).Conclusion The differen-tial expression of p57kip2 and p27kip1 in complete hydatidiform moles and partial hydatidiform moles can be of certain value in the differential diagnosis of hydatidiform moles.Meanwhile,the combined methed is useful to the identification and classification of hydatidiform moles.

Objective To investigate and analyze the current situation of the nurse anesthetists and their work situation in tertiary hospitals of Guangdong province and provide reference information for the standardization construction of perianesthesia nursing.Methods A self-designed questionnaire was used to survey the nurse anesthetists and their work situation in 53 tertiary hospitals in Guangdong province.Results There were 413 nurse anesthetists in total,and the setting rate of full-time head nurse in a department of anesthesiology was 32％ in 53 tertiary hospitals of Guangdong province.The occupational titles were mainly the primary title,and the constituent ratio was 61.7％;the educational backgrounds were mainly bachelor's degree,and the constituent ratio was 62％;ages mainly ranged from 26 to 39,and the constituent ratio was 55.7％.The main working contents were management of anesthesia supplies (drugs,disposable materials,apparatus and equipment),nursing in postanesthesia care unit,and cooperation and nursing for the anesthesia practice inside or outside the operating room.Conclusion Nurse anesthetists in the tertiary hospitals in Guangdong province are young,and their work involves a wide range with complicated contents,an unbalanced development in different districts has occurred,and thus the standardization construction of perianesthesia nursing should be further strengthened.

Objective To study the relationship between serum levels of C reactive protein,adiponectin and severity of disease,joint function in patients with rheumatoid arthritis(RA).Methods A total of 85 cases of RA treated in our hospital from September 2014 to August 2016 were selected into the RA group,and 20 healthy persons were recruited into control group.The serum C reactive protein,adiponectin were detected,compared in the two groups,and to investigate the relationship between them with severity of disease,joint function of the patients.Results C reactive protein of RA patients was(23.63±5.36) pg/mL,which was significant higher than that of the control group,the adiponectin,the ratio of C reactive protein and adiponectin were(4.64±1.74)ng/mL,0.37±0.06 respectively,which were significant lower than those of the control group,the differences were statistically significant(P<0.05).RA patients with more serious joint injury and disease status,the adiponectin,the ratio of adiponectin and C reactive protien were more lower,the C reactive protien was more higher,the differences in different joint injury and disease status groups were significant(P<0.05).Logistic analysis showed that adiponectin(P=0.04),the ratio of adiponectin and C reactive protien(P=0.01) were independent risk factors of bone damage in RA patients.Conclusion Serum C reactive protein and adiponectin level were closely related to the severity of RA and joint function.