With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

This article summarized the clinical experience of Professor LIN Yi in applying the idea of disease-syndrome-syptom combination to the differentiation and treatment of breast cancer in consolidation phase. It is believed that the fundamental pathogenesis of breast cancer in consolidation phase is deficiency of healthy qi， so the treatment should emphasize on reinforcing healthy qi as the main and eliminating pathogen as the supplement. Commonly， Sijunzi Decoction （四君子汤）， Shenling Baizhu Powder （参苓白术散）， and Liuwei Dihuang Decoction （六味地黄汤） are used as the basic formula to strengthen the spleen and kidney to reinforce healthy qi， and Baihua Sheshe Cao （Scleromitrion diffusum ［Willd.］ R.J.Wang）， Yiyiren （Coix lacryma-jobi L.）， and ezhu （Curcuma aromatica Salisb.） are used to eliminate cancer toxin. It is also believed that the biological characteristics of different molecular subtypes of breast cancer are of great significance to the syndrome differentiation and treatment in traditional Chinese medicine， therefore， the formulas used in clinical practice are often selected taking into considerations of molecular subtypes of breast cancer. For those with positive sex hormone receptor， the most important thing is to replenish the congenital and benefit kidney essence， with modified Baihua Qiqi Decoction （白花芪杞汤）； for those with negative sex hormone receptor， the first step is to strengthen spleen and replenish kidneys， and it is especially important to strengthen the spleen with Baihua Qiling Decoction （白花芪苓汤）. At the same time， it is suggested that the primary and the secondary symptoms of patients should be differentiated， and the diseases and symptoms， as well as the modern medical laboratory indicators should be combined to give suitable medication.

To analyze the current quality of treatment for hospitalized cancer patients in Beijing, identify major issues in treatment practices, and propose improvements.

Objective:To explore the clinical significance of recurrent laryngeal nerve inlet zone(RLNIZ) lymph node metastasis in papillary thyroid cancer(PTC).Methods:The clinical data of the clinicopathologic characteristics of 738 cases with papillary thyroid cancer at our centers from Jul 2017 to Jun 2018 was retrospectively reviewed. 108 cases with RLNIZ lymph node dissection for pathological examination were included. The relationship between metastasis of RLNIZ lymph node and clinicopathologic characteristics was analyzed.Results:RLNIZ lymph node was detected in 12.3%(91/738)cases, the mean lymph node number in RLNIZ was 1.5±0.7, and 30.8%(28/91) cases suffered RLNIZ lymph node metastasis. RLNIZ lymph node metastasis(LNM) is associated with tumor size( P=0.028), capsular invasion( P=0.019), No. of central compartment LNM( P<0.001) and lateral neck LNM( P<0.001). No. of central compartment LNM was found to be the independent risk factor of RLNIZ lymph node metastasis. The incidence of dysphagia and inferior parathyroid damage was 0.9%(1/108)respectively. Conclusions:RLNIZ lymph node metastasis is common among PTC patients , therefore, RLNIZ lymph node should be routinely removed especially in patients with tumor size over 1cm、suspected capsular invasion and lateral neck lymph node metastasis confirmed by preoperative imaging examination.

Objective:To explore the expression and clinical significance of miR-143 in papillary thyroid cancer (PTC) .Methods:Tumor samples and adjacent tissues from 52 patients with PTC were obtained from Jan. 1st, 2018 to Mar. 31st, 2018 in Thyroid Surgery Department of the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Quantitative reverse-transcriptase PCR (RT-qPCR) was used to measure the expression of miR-143 in those subjects. In addition, the relationship between the expression levels of miR-143 and the clinicopathological characteristics was analyzed.Results:RT-qPCR indicated that the expression of miR-143 was down-regulated in PTC, which was significantly lower than that in adjacent tissues ( t=-21.39, 95% CI: 18.20-15.07, P<0.001) . Low expression of miR-143 was related to the number of lymph node metastasis ≥3 in central compartment ( t=10.13, P=0.012) and lateral neck lymph node metastasis ( t=-4.67, P<0.001) . Conclusion:Downregulation of miR-143 in PTC is linked to the metastasis of PTC and may be a potential target for therapeutic intervention.

Exposure of airborne particulate matter (PM) with an aerodynamic diameter less than 2.5 lm (PM2.5) is epidemiologically associated with lung dysfunction and respiratory symptoms, including pulmonary fibrosis. However, whether epigenetic mechanisms are involved in PM2.5-induced pulmonary fibrosis is currently poorly understood. Herein, using a PM2.5-induced pulmonary fibrosis mouse model, we found that PM2.5 exposure leads to aberrant mRNA 5-methylcytosine (m5C) gain and loss in fibrotic lung tissues. Moreover, we showed the m5C-mediated regulatory map of gene functions in pulmonary fibrosis after PM2.5 exposure. Several genes act as m5C gain-upregulated factors, probably critical for the development of PM2.5-induced fibrosis in mouse lungs. These genes, including Lcn2, Mmp9, Chi3l1, Adipoq, Atp5j2, Atp5l, Atpif1, Ndufb6, Fgr, Slc11a1, and Tyrobp, are highly related to oxidative stress response, inflammatory responses, and immune system processes. Our study illustrates the first epitranscrip-tomic RNA m5C profile in PM2.5-induced pulmonary fibrosis and will be valuable in identifying biomarkers for PM2.5 exposure-related lung pathogenesis with translational potential.

Objective To analyze the cosmetic effects and postoperative complications of patients with early breast cancer who underwent oncoplastic breast-conserving reconstruction and traditional breast-conserving surgery.Methods From January 201 2 to October 201 5,we collected a total of 67 patients with early-stage breast cancer who underwent breast-conserving surgery in Affiliated Mindong Hospital of Fujian Medical Univer-sity.Thirty patients who underwent oncoplastic breast-conserving reconstruction were in observation group,and 37 patients who underwent traditional breast-conserving surgery were in the control group.The postoperative complications,cosmetic effects and survival situations in the two groups were compared.Results In the aes-thetic effects evaluation,22 patients (73.33%)and 1 6 patients (43.24%)had good or excellent cosmetic effects,6 patients (20.00%)and 1 4 patients (37.84%)had general cosmetic effects,2 patients (6.67%) and 7 patients (1 8.92%)had poor cosmetic effects in the observation group and control group,with a signifi-cant difference (Z =-2.51 3,P =0.01 2).Four patients (1 3.33%)in the observation group had postopera-tive complications,including that 1 patients had incisional dehiscence followed by incisional wound infection and skin necrosis,and 3 patients had subcutaneous exudates.However,2 patients (5.41 %)in the control group had postoperative complications,including 1 patients with incisional dehiscence,and 1 patients with inci-sional wound infection.There were no significant difference in the occurrence rates of postoperative complica-tions in the two groups (χ2 =0.490,P =0.484).The mean follow-up period was 28 months.We found 1 patients of local recurrence,and 2 patients of metastases in the control group.However,all patients were free of recurrence and metastases in the observation group,with no significant difference (P =0.1 40).Conclusion Oncoplastic surgical technique in the breast-conserving surgery for patients with early-stage breast cancer is a safe and effective procedure,with highly satisfactory cosmetic effects for the majority of patients,which is worth to recommend.

OBJECTIVETo evaluate the effect of early enteral nutrition(EEN) on immune response and clinical outcomes after esophageal cancer operation.

METHODSSixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method: EEN group(n=30, administration of water and enteral nutrition early after operation) and TPN group(n=30, administration of total parenteral nutrition). Two groups both received 7-day nutrition support. Immune indexes(CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and serum nutritional indexes(albumin, pre-albumin, transferrin) were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded.

RESULTSAs compared to TPN group, the time to first flatus was significantly shorter in EEN group[(66.5±7.3) h vs. (75.1±6.8) h, P<0.01], as was hospital stay[(7.8±1.1) d vs. (9.3±1.3) d, P<0.01]. Total hospitalization cost[(36 210±3810) yuan vs. (39 731±4013) yuan, P<0.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups[13.3%(3/30) vs. 20.0%(6/30), P>0.05]. The levels of CD3(+), CD4(+), CD4(+)/CD8(+), albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7(all P<0.05), while CD8(+) was significantly lower in EEN group(P<0.05).

CONCLUSIONEEN can promote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.

Objective To evaluate the effect of early enteral nutrition (EEN) on immune response and clinical outcomes after esophageal cancer operation. Methods Sixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method: EEN group (n=30, administration of water and enteral nutrition early after operation) and TPN group (n=30, administration of total parenteral nutrition). Two groups both received 7-day nutrition support. Immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) and serum nutritional indexes (albumin, pre-albumin, transferrin) were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded. Results As compared to TPN group, the time to first flatus was significantly shorter in EEN group [(66.5±7.3) h vs. (75.1±6.8) h, P<0.01], as was hospital stay[(7.8±1.1) d vs. (9.3±1.3) d, P<0.01]. Total hospitalization cost[(36 210± 3810) yuan vs. (39 731 ±4013) yuan, P<0.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups [13.3%(3/30) vs. 20.0%(6/30),P>0.05]. The levels of CD3+, CD4+, CD4+/CD8+, albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7 (all P<0.05), while CD8+ was significantly lower in EEN group (P<0.05). Conclusion EEN can promote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.

Objective To evaluate the effect of early enteral nutrition (EEN) on immune response and clinical outcomes after esophageal cancer operation. Methods Sixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method: EEN group (n=30, administration of water and enteral nutrition early after operation) and TPN group (n=30, administration of total parenteral nutrition). Two groups both received 7-day nutrition support. Immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) and serum nutritional indexes (albumin, pre-albumin, transferrin) were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded. Results As compared to TPN group, the time to first flatus was significantly shorter in EEN group [(66.5±7.3) h vs. (75.1±6.8) h, P<0.01], as was hospital stay[(7.8±1.1) d vs. (9.3±1.3) d, P<0.01]. Total hospitalization cost[(36 210± 3810) yuan vs. (39 731 ±4013) yuan, P<0.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups [13.3%(3/30) vs. 20.0%(6/30),P>0.05]. The levels of CD3+, CD4+, CD4+/CD8+, albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7 (all P<0.05), while CD8+ was significantly lower in EEN group (P<0.05). Conclusion EEN can promote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.