OBJECTIVE：To improve the quality standard of M ongolian med icine Artemisia sacrorum ，and to provide scientific basis for comprehensive quality evaluation. METHODS ：The appearance and microscopic characteristics of A. sacrorum were identified；scopoletin，chlorogenic acid ，caffeic acid ，scopoletin and 3，5-dicaffeoylquinic acid were identified quantitatively by TLC；the contents of above 5 components were determined by HPLC. The water content ，total ash and extract were examined. RESULTS：The stem of A. sacrorum was cylindrical ，and its surface was purple or purple-brown or cyan-brown ；the leaves were ovate or oblong-ovate ，fragrant；the flowers were yellow ，head-shaped，subglobose or hemispherical. The powder was green or yellow-green，its pollen grain had three germination ；the parenchymal cell clusters with sharp edges and numerous threaded ducts ， occasionally having marginal pitted ducts ；its wood fibers were in bundles mostly. Results of TLC showed that the spots of the same color were found in the corresponding positions of chromatogram for 5 substance control and samples. The linear range of scopoletin， chlorogenic acid ， caffeic acid ， scopolactone and 3，5-dicaffeoylquinic acid were 85.60-428.00， 10.16-101.60， 10.20-102.00，40.84-408.40 and 40.80-408.00 μg/mL（all r＞0.999 0）. RSDs of precision ，stability，repeatability tests were all less than 3.00％（n＝6）. The average recoveries were 103.07％，99.66％，98.37％，97.78％，98.40％（all RSDs ＜3.00％，n＝6）. The contents of the above-mentioned 5 compounds in 10 batches of samples were 0.36％-1.23％，0.09％-0.51％，0.04％-0.13％， 0.61％ -1.13％ ，0.12％ -1.11％ ，respectively；the average com contents of water ，total ash and water soluble extract were 6.25％，5.86％，26.50％，respectively. CONCLU SIONS：O the basis of the original quality standard of A. sacrorum ， microscopic identification，TLC identification ，content determination and examination items of water ，total ash and extract are added. The method shows good precision ，accuracy and stability ，which can provide reference for more scientific and standardized evaluation of the quality of this medicinal material.

OBJECTIVE：To provide scientifi c evidence for improving the quality standard of Mongolian medicine Juniperus rigida. METHODS ：Totally 10 batches of J. rigida from different places were taken as samples to observe their characters and identify them by microscope ；TLC method was adopted to qualitatively identify isoquercitrin ，quercitrin，amentoflavone， podocarpusflavone A and hinokiflavone ；the contents of total ash ，acid-insoluble ash ，ethanol-soluble extract and heavy metals were determined by related method stated in 2020 edition of Chinese Pharmacopeia （part Ⅳ）. The contents of above 5 components in samples were determined by HPLC. RESULTS ：The powder of J. rigida was green or yellowish green ，polygonal tracheids ， closely arranged in longitudinal with unequal stomatal ；epidermal cells were nearly rectangular ；sclerenchyma cells were quasi rectangular and the wall beadedly thickening. Results of TLC showed that the spots of the same color were found in the corresponding positions of chromatogram for test sample and substance control. The contents of total ash ，acid-insoluble ash and ethanol-soluble extract in 10 batches of samples were 7.37％-11.18％，0.75％-2.98％，16.55％-26.42％，respectively；average contents were 8.51％，1.27％，22.35％. The contents of lead ，arsenic，cadmium，mercury and copper were 2.00-5.44，0.65-1.65， 0.044-0.100，0.034-0.160，4.59-6.79 mg/kg，respectively；average conte nts were 3.73，0.97，0.078，0.061，5.23 mg/kg. The linear ranges of isoquercitrin ，quercitrin，amentoflavone，podocarpus- flavone A and hinokiflavone were 4.98-20.02，49.99-199.96， 19.94-99.96，9.99-40.00，20.20-159.98 μg/mL（all r＞0.999 7）； com RSDs of precision ，repeatability and stability （24 h） tests were all less than 3.00％（n＝6）；the average recoveries were 话：0993-2057878。E-mail：Tanghuishz@qq.com 100.62％-102.96％，RSDs were 1.21％-1.88％（n＝6）. Average contents of the above-mentioned 5 compounds in 10 batches of samples were 0.089-0.379，1.379-4.250，1.077-2.026，0.162-0.423， 0.016 9-0.117 0 mg/g，respectively. CONCLUSIONS ：The qualitative and quantitative analysis methods of Mongolian medicine J. rigida are established. It is preliminarily proposed that the total ash content shall not exceed 10.22％，the acid-insoluble ash content shall not exceed 1.53％，ethanol-soluble extract content shall not be less than 17.88％，heavy metal lead should not exceed 5 mg/kg，arsenic should not exceed 2 mg/kg，cadmium should not exceed 0.3 mg/kg，mercury should not exceed 0.2 mg/kg，copper should not exceed 20 mg/kg.

Objective:To explore the management mode of the real-time reimbursement of testing expenses in clinical trials, dealing with the possible disadvantages of manual reimbursement and improving work efficiency.Methods:Based on hospital information system, the GCP center integrates the clinical trial information system, optimizes the trial reimbursement process, and explores a unique " clinic-GCP-finance" streamlined clinical trial real-time settlement management model.Results:This management mode of real-time reimbursement of testing expenses has been adopted for 3 years. This management model enables human subjects to complete the reduction or exemption of clinical trial-related medical testing expenses before making the payments, which is also highly praised by both investigators and subjects.It complied with informatization and technology development in the era of big data, realized full process dynamic supervision over clinical trial lab testing expenses and avoided management delay. It also had advantages in simplifying reimbursement process, reducing work load and mistakes, complying with inspection and improving trial quality.Conclusions:Clinical trial real-time reimbursement management mode of testing expenses works better in compliance with GCP, safeguards the rights and interest of human subject, and can provide a certain reference for other GCP centers.

Objective:To assess the effectiveness of influenza vaccine in children aged 6-72 months.Methods:The cohort study was conducted based on community child vaccination clinics in Yiwu and Yongkang counties of Zhejiang province. From October 2017 to December 2017, a total of 1 752 children aged 6-72 months were enrolled from 10 child vaccination clinics. The questionnaire survey was conducted after the written consents were obtained from the parents or legal guardians of the children. Then, a follow up was conducted for enrolle children until 30 April 2018, the influenza vaccination status and the number of influenza-like illness (ILI) cases, hospital visit due to ILI, self-medication due to ILI were observed and recorded every month. Vaccine effectiveness (VE) was estimated by using the generalized linear model (GLM) where dependent variables were the number of ILI cases, hospital visit and self-medication respectively.Results:Of the 1 752 children, 925 (52.80%) were boys and the median age was 30.00 months. The cumulative observation was 308 166 person days at the end of 2017-2018 season, with 5.27 ILI cases per 1 000 person days, 3.41 hospital visit due to ILI per 1 000 person days, 1.45 self-medication due to ILI per 1 000 person days. Of the 1 752 children, 643 received the influenza vaccination in 2017-2018 season. Compared with unvaccinated children, the VE was 23.5% against ILI case number (95% CI: 15.1%-31.1%), 19.3% against hospital visit due to ILI (95% CI: 8.2%-29.1%) and 25.8% against self-medication due to ILI (95% CI: 9.3%- 39.3%). Modeling splitting 643 children with 2017-2018 vaccination into those before and after vaccination, the influenza VE was 31.9% against ILI case number (95% CI: 12.7%-46.9%), 32.6% against hospital visit due to ILI (95% CI: 8.6%-50.3%) and 44.3% against self-medication due to ILI (95% CI: 11.9%-64.8%) in children aged 36-72 months. However, the children aged 6-35 months showed no significant VEs. For the VE analysis in children with different vaccination status, the VEs were significant if they received vaccination in both 2016-2017 season and 2017-2018 season or only in 2017-2018 seasons. The VE was not demonstrated among the children who were immunized only in 2016-2017 season. Conclusion:Influenza vaccination is moderate effective in preventing the incidence of ILI and hospital visit and self-medication in children in influenza season, the protection effect in children aged 36-72 months is better than that in children aged 6-35 months.

Objective To explore the influence of disability acceptance and resilience on stigma in laryngeal carcinoma patients with permanent tracheostomy and analyze the impact path. Methods From June 2016 to August 2018, this study selected 264 laryngeal carcinoma patients with permanent tracheostomy of Inpatient and Outpatient Department in Guangxi Medical University Affiliated Tumor Hospital as subjects by convenience sampling. All patients were investigated with the Social Impact Scale (SIS), Acceptance of Disability Scale (AODS) and the 10-item Connor-Davidson Resilience Scale (CD-RISC10). The correlations were analyzed and structure equation model was used to path analysis. A total of 264 questionnaire were sent out and 256 valid questionnaires were collected. Results Among those patients with permanent tracheostomy, the total scores of stigma, disability acceptance and resilience were (61.50±9.27), (76.88±9.34) and (26.49±4.05) respectively. Correlation analysis showed that the scores of disability acceptance and resilience had negative correlations with stigma with statistical differences (P< 0.01). Structure equation model analysis showed that disability acceptance and resilience of laryngeal carcinoma patients with permanenttracheostomy had direct effect on stigma (β=-0.43,-0.28), the indirect effect of disability acceptance on stigma by resilience was -0.06. Conclusions Laryngeal carcinoma patients with permanenttracheostomy have a high level of stigma, the disability acceptance and resilience has significant roles on stigma.

Objective To explore the relationship between iodine and fluoride content in drinking water and the incidence of adult thyroid nodules in Cangzhou,Hebei.Methods According to the previous reports on iodine and fluoride levels in drinking water in Cangzhou,from November 2016 to January 2017,Cangzhou was divided into high iodine,low iodine,normal iodine and fluorine,low iodine and high fluorine,high iodine and high fluorine areas,and according to the different contents of iodine and fluorine in drinking water,high iodine and high fluorine area was further divided into high iodine and high fluorine 1 (iodine:743.30 μg/L,fluorine:4.27 mg/L),2 (iodine:119.31μg/L,fluorine:4.67 mg/L) and 3 (iodine:105.30 μg/L,fluorine:1.64 mg/L) subareas.Subjects who lived for 20 or more years and aged 30 or older,without serious disease and not taken iodized salt were selected.Palpation was used to examine the size,texture,mass,tenderness and mobility of the thyroid gland.The boundary,internal echo,blood flow and quantity of nodules were observed and recorded by color Doppler.Results The prevalence difference of thyroid nodules [36.8％ (629/1 710),32.8％ (636/1 938),25.1％ (427/1 700)] in high iodine,low iodine and normal iodine and fluorine areas was statistically significant (x2 =55.597,P ＜ 0.05).The prevalences of thyroid nodules in both high iodine and low iodine areas were higher than that of normal iodine and fluorine area (P＜ 0.016 7).The prevalence difference of thyroid nodules [43.3％ (749/1 730),39.8％ (712/1 790),34.9％ (623/1 785)] in high iodine and high fluorine 1,2 and 3 subareas was statistically significant(x2 =26.220,P ＜ 0.05).Compared with low iodine area,the prevalence of thyroid nodules [41.2％ (735/1 785)] in low iodine and high fluorine area was increased (x2 =6.288,P ＜ 0.05).Conclusions Both high iodine and low iodine can induce thyroid nodules.In water source areas with high iodine content,both high iodine and high fluorine are the factors inducing thyroid nodules.The prevalence of thyroid nodules in low iodine and high fluorine area is significantly higher than that of low iodine area.

OBJECTIVETo assess the association of programmed cell death 1 (PDCD1) gene polymorphisms with the susceptibility and/or progression of colorectal cancer.

METHODSA hospital-based case-control study was carried out, which recruited 426 colorectal cancer patients and 500 healthy individuals. Five single nucleotide polymorphisms, namely rs36084323, rs11568821, rs2227981, rs2227982 and rs10204525, were selected for the study and genotyped with a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay.

RESULTSThe G allele of rs36084323 under a dominant model was associated with increased risk of advanced TNM staging of colorectal cancer progression (OR=1.59, 95%CI=1.02-2.48). Haplotypes G-G-C-T-A and A-G-C-C-G of the rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525 were negatively associated with the occurrence of colorectal cancer.

CONCLUSIONThe G allele of rs36084323 is associated with increased risk of advanced TNM staging of colorectal cancer. Conversely, the incidence of colorectal cancer is negatively associated with the haplotypes G-G-C-T-A and A-G-C-C-G of rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525.

Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; China ; ethnology ; Colorectal Neoplasms ; genetics ; pathology ; Genetic Predisposition to Disease ; Haplotypes ; Humans ; Neoplasm Staging ; Polymorphism, Single Nucleotide ; Programmed Cell Death 1 Receptor ; genetics

Objective To construct a rating scale on the knowledge,attitude,and practice of geriatrics for 8-year clinical medical students and undergraduate nursing students,and to test the reliability and validity of the scale.Methods The Knowledge,Attitude,Practice(KAP)theory was used as a guided framework,relative literatures were reviewed,and topics for question answering were discussed by experts group.Then,a questionnaire was initially constructed.Five methods,including discrete trend method,Cronbach coefficient,t-test,correlation analysis,and factor analysis,were used to screen the attitude and practice items.The knowledge items were evaluated by experts.Items with over three exclusion criteria were deleted when combining the literal questions.The construct validity of the integrated scale was assessed by factor analysis.A pilot research was conducted by 100 eight-year medical students and nursing undergraduates selecting question entries,and the reliability and validity of the scale were examined.Results The scale consisted of three dimensions.A 43-item initiate questionnaire on the scale included 13 items for knowledge,11 for attitude,and 19 for practice.Two knowledge items were deleted according to expert evaluation.Seven items with more than three exclusion criteria were deleted after statistical analyses.Eventually,34 items were included in the questionnaire.The Cronbach α coefficient of the questionnaire was 0.702.And three common factors were extracted according to exploratory factor analysis.Conclusions The reliability and validity of Geriatrics Knowledge,Attitude and Practice scale for eight year medical students and nursing undergraduates are acceptable,but the knowledge items should be recomposed.

OBJECTIVE To explore risk factors of cervical lymph node metastasis in cN0 papillary thyroid carcinoma. METHODS The clinical data of 537 patients with cN0 papillary thyroid carcinoma were analyzed retrospectively in Beijing Tongren hospital from Jan 2009 to Dec 2015. Patients' gender, age, multifocal lesion, carcinoma complicated with Hashimoto's thyroiditis, capsule breakthrough and tumor size were counted. RESULTS The lymph node metastasis rate of 537 patients with cN0 papillary thyroid carcinoma was 30.9%(166/537). The incidences of lymph node involvement were 24.95%(166/537) at only level VI, 5.21%(28/537) at level VI plus lateral part of neck and 0.74%(4/537) at only skip metastasis, respectively. Chi square test and multivariate logistic regression analysis showed that cervical lymph node metastasis was statistically associated with male, age<45 years, capsule breakthrough and tumor diameter>1 cm (P<0.05). After the operation, there were 17 patients with temporary hoarseness, accompanied with 1 loss to follow-up and 1 failure to return to normal after 1.5 years. There were 61 patients with temporary hypocalcemia, 2 patients failed to follow-up and 2 patients with calcium supplements after respective 1.5 and 4 years. CONCLUSION To stratify the risk of patients with cN0 papillary thyroid carcinoma, male, age<45 years, capsule breakthrough and tumor diameter>1 cm are risk factors for cervical lymph node metastasis. And we suggest that prophylactic central lymph node dissection may be appropriate.