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The study investigates the therapeutic effects and mechanisms of ginsenoside Rg_1(GRg_1) on sepsis-induced acute lung injury(SALI). A murine model of SALI was created using cecal ligation and puncture(CLP) surgery, and mice were randomly assigned to groups for GRg_1 intervention. Survival and body weight changes were recorded, lung function was assessed with a non-invasive lung function test system, and lung tissue damage was evaluated through HE staining. The content and expression of inflammatory factors were measured by ELISA and qRT-PCR. Apoptosis was examined using flow cytometry and TUNEL staining. The activation and expression of apoptosis-related molecules cysteinyl aspartate specific proteinase 3(caspase-3), B-cell lymphoma-2(Bcl-2), Bcl-2 associated X protein(Bax), and endoplasmic reticulum stress-related molecules protein kinase R-like endoplasmic reticulum kinase(PERK), eukaryotic initiation factor 2α(eIF2α), activating transcription factor 4(ATF4), and C/EBP homologous protein(CHOP) were studied using Western blot and qRT-PCR. In addition, an in vitro model of lipopolysaccharide(LPS)-induced lung alveolar epithelial cell injury was used, with the application of the endoplasmic reticulum stress inducer tunicamycin to validate the action mechanism of GRg_1. RESULTS:: indicated that, when compared to the model group, GRg_1 intervention significantly enhanced the survival time of CLP mice, mitigated body weight loss, and improved impaired lung function indices. The GRg_1-treated mice also displayed reduced lung tissue pathological scores, a reduced lung tissue wet-to-dry weight ratio, and lower protein content in the bronchoalveolar lavage fluid. Serum levels of interleukin-6(IL-6), interleukin-1β(IL-1β), and tumor necrosis factor-α(TNF-α), as well as the mRNA expressions of these cytokines in lung tissues, were decreased. There was a notable decrease in the proportion of apopto-tic alveolar epithelial cells, and down-regulated expressions of caspase-3, Bax, PERK, eIF2α, ATF4, and CHOP and up-regulated expression of Bcl-2 were observed. In vitro findings showed that the apoptosis-lowering and apoptosis-related protein down-regulating effects of GRg_1 were significantly inhibited with the co-application of tunicamycin. Altogether, GRg_1 reduces apoptosis of alveolar epithelial cells, inhibits inflammation in the lungs, alleviates lung injury, and enhances lung function, possibly through the PERK/eIF2α/ATF4/CHOP pathway.

In this study, we sought to quantify the effect of planting structure change on fertilizer input and environmental cost in Chongqing and develop scientific and rational strategies for chemical fertilizer reduction. Based on the crop fertilizer quota standard and large sample farmer survey data under the medium productivity level in Chongqing, we evaluated and analyzed the application reduction potential and environmental benefits of fertilizer with the difference method and life cycle assessment. The results showed that:① since Chongqing became a municipality directly under the central government (1997), Chongqing crop planting structure had greatly changed, and the proportion of food crop (rice, corn, wheat, bean, and potato) decreased by 21%. The area of fruits and vegetables increased from 3.36×10 5 hm 2 to 1.05×10 6 hm 2 , and their proportion increased by 20%. ② Nearly 55% of fertilizers had been consumed by vegetable (37%) and citrus production systems, and 11%, 12%, and 12% of fertilizers were consumed by rice, corn, and potato, respectively. ③ The total fertilizer reduction of the Chongqing planting industry could reach up to 1.69×10 5 tons during the period of "the 14th Five-Year Plan," with a fertilizer reduction potential of 18.6%. The fertilizer reduction potential (reduction amount) of rice, corn, citrus, and vegetables would reach 0.3% (2.9×10 2 tons), 12% (1.45×10 4 tons), 21% (3.65×10 4 tons), and 30% (1.18×10 5 tons), respectively. On the other hand, the rape system was insufficient in phosphorus potassium fertilizers, and the corn tended to be insufficient in potash fertilizer. ④ The current production level was low, and the nitrogen loss, greenhouse gas emissions, and eutrophication potential in the planting industry of Chongqing reached 1.81×10 5 tons (N), 1.43×10 7 tons (CO 2 -eq), and 1.74×10 5 tons (PO 4 -eq). With the increase in the realization degree of the crop quota standard (60%-100%), the reactive nitrogen loss, greenhouse gas emissions, and eutrophication potential decreased by 14.9%-24.9%, 10.1%-16.7%, and 13.8%-23%, respectively. The structure of the planting industry in Chongqing significantly changed, the total fertilizer consumption in Chongqing tended to decline gradually, and the fertilization intensity of commercial crops stayed at a high level. The agricultural fertilizer reduction potential and the reactive nitrogen and greenhouse gas emission reduction potential were large, especially for citrus and vegetable production systems. However, it is also necessary to pay attention to insufficient corn potash fertilizer and rape phosphorus potassium fertilizer investment and carry out collaborative promotion of fertilizer reduction.

It is of great practical significance to identify service blind area, scientifically select park construction areas, and clarify the priority of parks' construction based on the co-ordination of supply-demand evaluation. With the urban parks within the Taiyuan Ring Expressway as the research subjects, we estimated the accessibility range and the service pressure of each park by using the application programming interface of Gaode map route planning and point of interest data to characterize their supply and demand levels. We identified the service blind areas of parks by overlay analysis, and used the location-allocation (LA) model to purposefully supply park green space. Results showed that the accessibility coverage rates of the parks by walking and bicycling within 15 minutes were 35.6% and 71.7%, respectively, indicating insufficient supply capacity of parks. The areas with large potential demand for park green space in Taiyuan were mainly concentrated in the business district of Qinxian-Changfeng Street and the Shuangta business district within Dongzhong ring road, which existed the obviously invisible blind areas. Finally, we proposed new park green space site selection proposal based on LA model. Optimization results indicated that the coverage rates of walking and bicycling within 15 minutes increased to 46.7% and 81.0%, respectively, and that the service pressure of parks was relieved. We combined the leisure demands of urban residents and the distribution of urban parks by utilizing network big data, which could promote the scientific nature and accuracy of the optimizing site selection and provide scientific method and theory basis for urban park construction.

Objective: To establish a nested recombinant enzyme-assisted polymerase chain reaction (RAP) technique combined with recombined mannose-binding lectin protein (M1 protein)-magnetic beads enrichment for the detection of Candida albicans ( C. albicans ) and Candida tropicalis ( C. tropicalis ) in blood samples for the early diagnosis of candidemia albicans and candidiemia tropicalis. Methods: The primer probes for highly conserved regions of the internal transcribed spacerregions of C. albicans and C. tropicalis were deigned to establish RAP assays for the detections of C. albicans and C. tropicalis ; The sensitivity and reproducibility of nucleic acid tests with gradient dilutions of standard strains and specificity of nucleic acid tests with common clinical pathogens causing bloodstream infection were condcuted. M1 protein-magnetic bead enriched plasma C. albicans and C. tropicalis were used for RAP and PCR in with simulated samples and the results were compared. Results: The sensitivity of the established dual RAP assay was 2.4-2.8 copies/reaction, with higher reproducibility and specificity. M1 protein-magnetic bead enrichment of pathogen combined with the dual RAP assay could complete the detections of C. albicans and C. tropicalis in plasma within 4 hours. Fie the pathogen samples at concentration <10 CFU/ml, the number of the samples tested by RAP was higher than that tested by PCR after enrichment. Conclusion: In this study, a dual RAP assay for the detections of C. albicans and C. tropicalis in blood sample was developed, which has the advantages of accuracy, rapidity, and less contaminants and has great potential for rapid detection of Candidemia.

Objective: To understand the detection rate, epidemic pattern of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory tract infection (ALRTI) in China. Methods: From June 2017 to March 2020, a prospective multi-center study on the viral aetiology among hospitalized children with ALRTI was conducted in six pediatrics hospital of North China, Northeast, Northwest, South China, Southeast, and Southwest China. A total of 2 839 hospitalized children with ALRTI were enrolled, and the respiratory specimens were collected from these cases. A multiplex real-time RT-PCR assay were employed to screen the respiratory viruses, and the molecular epidemiological and clinical characteristics of children infected with RSV were analyzed. Results: The positve rate of RSV was 18.6% (528/2 839), and the positive rate of RSV in different regions ranged from 5.5% to 44.3%. The positive rate of RSV in male was higher than that in female (20.2% vs 16.3%), and there was a significant statistically difference between two groups (χ2=6.74, P=0.009). The positive rate of RSV among children under 5 years old was higher than that among children older than 5 years old (22.3% vs 4.5%), and there was a significant statistically difference between two groups (χ2=97.98,P<0.001). The positive rate of RSV among the <6 months age group was higher than that of other age groups (all P<0.05). During January 2018 and December 2019, RSV was detected in almost all through the year, and showed peaks in winter and spring. RSV-positive cases accounted for 17.0% (46/270) among children with severe pneumonia, including 36 cases infected with RSV alone. Conclusion: RSV is an important viral pathogen in children under 5 years old with ALRTI in China. The virus can be detected almost all through the year and reached the peak in winter and spring. RSV could lead to severe pneumonia in children and caused huge threaten to children's health.

The accumulation of antibiotics in farmland and its ecological risk have become a research hotspot at home and abroad. The objective of this study was to investigate the occurrence and accumulation of antibiotics and their potential environmental and ecological risks in vegetable fields in Kaizhou district of Chongqing country. The occurrence characteristics of antibiotics including tetracyclines, sulfonamides, quinolones, macrolides, and chloramphenicols were detected using experimental analysis. The results showed that there was an accumulation of antibiotics in the vegetable soil, and 18 antibiotics in five categories were detected (0-42.88 μg·kg -1 ), mainly for tetracyclines and quinolones. The detection rate of quinolone antibiotics was the highest (15.38%-100%), especially for norfloxacin and ofloxacin (100%), whereas the tetracyclines presented the highest concentration (0-42.88 μg·kg -1 ). The amount of total antibiotics in the vegetable soil was 1.64-233.11 μg·kg -1 , whereas different vegetable soils showed the following trend:water spinach soil (89.73 μg·kg -1 )>cabbage soil (32.53 μg·kg -1 )>pepper soil (32.16 μg·kg -1 )>tomato soil (32.13 μg·kg -1 )>cucumber soil (26.46 μg·kg -1 )>grassland (7.32 μg·kg -1 ). The correlation results showed that there was a significantly positive correlation between total antibiotic residues and organic fertilizer application ( P <0.05) but a significantly negative correlation with soil pH ( P <0.05). Quinolones and sulfonamides were negatively correlated with soil water content ( P <0.05), whereas quinolones positively correlated with soil available phosphorus and organic matter content ( P <0.05). The potential eco-environmental risk assessment results showed that tetracyclines and quinolones in vegetable soil in Kaizhou district had certain ecological risks, of which 62%-92% and 62%-100% of soil samples with quinolones had potential toxicity to soil animals and microorganisms.

Due to the long-term excessive fertilization in the vegetable system in China, nitrogen use efficiency (NUE) is low, and the environmental problem is serious. Nitrogen fertilizer combined with nitrification inhibitor is an effective strategy to alleviate the loss of active nitrogen and increase vegetable yield. However, systematic research on the above is lacking. Meta-analysis was used to systematically analyze the effects of nitrogen fertilizer combined with nitrification inhibitors[dicyandiamide (DCD), 3,4-dimethylpyrazole phosphate (DMPP), and 2-chloro-6-(trichloromethyl)pyridine (NP)] on the yield, plant nitrogen uptake, nitrogen fertilizer use efficiency, and nitrous oxide emission reduction effects in vegetable production in China. This study further revealed the impacts of different field management measures on their effects. The results showed that the combination of nitrogen fertilizer and nitrification inhibitor could significantly increase vegetable yield (9.2%), plant nitrogen uptake (10.4%), and nitrogen fertilizer use efficiency (11.2%) but reduce nitrous oxide emissions (28.4%). Among the different types of nitrification inhibitors, NP had the highest impact on the yield-increasing effect and the nitrous oxide emission reduction effect, which were 16.1% and 32.0%, respectively, followed by that of DMPP and DCD. Nitrification inhibitors could significantly increase vegetable yield (6.7%-14.7%) and reduce N 2 O emissions (14.6%-36.8%) in different nitrogen fertilizer rates. In neutral and alkaline vegetable soil, the yield-increasing effect and the reduction effect of nitrous oxide were higher than those in acidic soil. Nitrification inhibitors had significant effects on yield increase and nitrous oxide reduction under the conditions of greenhouse or open-field cultivation, root vegetables, and leafy vegetables. Principal component analysis (PCA) showed that soil total nitrogen content and soil pH were the main factors that promoted the increase in vegetable yields and drove nitrous oxide emissions under the application of nitrification inhibitors. In summary, nitrification inhibitors were an important measure to achieve the goal of improving quality and fertilizer use efficiency, while saving fertilizer and reducing emissions in vegetable production. Farmers should choose suitable types of nitrification inhibitors according to soil and field management measures to maximize their effectiveness.

Objective: To investigate the status of transfusion-transmissible infection (TTI) among voluntary blood donors in Nanjing in recent five years, in order to provide data support for the recruitment of blood donors and formulation and updating of blood screening strategies., Methods: HIV/HBV/HCV/TP serological markers were detected by ELISA in 487 120 blood donors in Nanjing from 2016 to 2020. Confirmatory assay was applied in anti-HIV positive samples by Nanjing Municipal Center for Disease Control and Prevention. The prevalence of TTI was calculated and the trend of disease was analyzed under different demographic groups., Results: The total positive rate of TTI in blood donors was 0.49% (2 411/487 120), in which the overall seroprevalence rate of HBsAg, anti-HCV, anti-HIV and anti-TP was 0.23%, 0.09%, 0.01% and 0.16%, respectively. The overall prevalence of HIV and TP remained relatively steady (P>0.05), whereas HBV and HCV decreased year by year (P<0.05). The prevalence of TTI was higher among people with lower education level, high age group and first-time blood donation., Conclusion: The prevalence of TTI among voluntary blood donors in Nanjing is at a low level from 2016 to 2020, but the risk still exists. The recruitment of regular donors and the improvement of blood screening technology can effectively reduce the risk of TTI.

Heavy metal contamination is one of the main factors causing ecological and environmental degradation. Soil contamination by heavy metals decreases soil quality, reduces agricultural productivity and quality, and even threatens human health. Therefore, optimizing remediation strategies for soils polluted with heavy metals is of great significance for high-yield, good-quality, and sustainable agriculture. Numerous domestic and foreign scholars have carried out a large number of studies on the phytoremediation of heavy metal contaminated soils. However, the remediation efficiency may be restricted by soil and climatic/environmental conditions. The synergistic remediation of microorganisms and plants is considered an effective means to improve metal remediation efficiency under environmental stresses. Metal-resistant plant growth-promoting bacteria (PGPB) not only promote plant growth and its resistance to biotic (e.g., phytopathogens, etc.) and abiotic (e.g., drought, salinity, extreme temperatures, heavy metals, etc.) stresses but also alter meal bioavailability in soils and metal toxicity in plants, thereby improving phytoremediation efficiency. In this paper, the mechanisms involved in promoting plant growth and its stress tolerance, and affecting metal bioavailability by metal-resistant PGPB, were systematically summarized. Furthermore, research progress on the application of PGPB in ecological restoration in recent years was extensively reviewed.

Objective To study the correlation of B-type natriuretic peptide(BNP)level with hemodynamic parameters and inflammatory cytokines in patients with Gram-negative sepsis,and further determine the main factors for the significant increase of BNP level. Methods The prospective study method was applied,and septic patients infected with Gram-negative bacteria from May 2017 to October 2019 were enrolled.The patients were divided into the BNP<2400 ng/L group and the BNP≥2400 ng/L group by taking the average value of BNP as the dividing point.The independent predictors of BNP≥2400 ng/L were analyzed by Logistic regression.Pearson correlation analysis was used to analyze the correlation between BNP and various indicators. Results A total of 106 patients with Gram-negative sepsis were included,among which 60 cases present with higher serum BNP levels than the average of(2398.45 ± 421.45)ng/L.Thus BNP≥2400 ng/L was considered as a significantly increased BNP level.Multiple logistic regression analysis showed that cardiac index(CI)[odds ratio ( OR )=0.428,95% confidence interval (95% CI )=0.743-0.965, P =0.011],left ventricular ejection fraction(LVEF) ( OR =0.394,95% CI =0.182-0.549, P =0.013),lactic acid ( OR =1.983,95% CI =1.264-3.420, P =0.023),endotoxin ( OR =6.146,95% CI =4.091-8.226, P =0.001),procalcitonin(PCT) ( OR =6.513,95% CI =4.365-8.210, P =0.005) and cardiac troponin I(cTnI) ( OR =1.144,95% CI =1.001-2.150, P =0.047) were independent predictors of BNP≥2400 ng/L in patients with Gram-negative sepsis.Pearson correlation analysis showed that BNP was negatively correlated with CI( R =-0.514, P <0.001)and LVEF ( R =-0.552, P <0.001),whereas positively correlated with lactic acid ( R =0.265, P =0.032),cTnI ( R =0.204, P =0.036),PCT( R =0.801, P <0.001),and endotoxin( R =0.765, P <0.001). Conclusions In septic patients with Gram-negative bacterial infection,LVEF,CI,lactic acid,cTnI,endotoxin and PCT are all independent risk factors for the significant increase of BNP,and endotoxin and PCT were more significantly correlated with BNP increase.Endotoxin and inflammatory reaction may be the more important stimulators of BNP increase in septic patients with Gram-negative bacterial infection.

Objective: To explore the clinical utility of bronchoscopy and transbronchial cryotherapy in children with tracheobronchial tuberculosis (TBTB). Methods: Retrospective study was conducted to collect the clinical data of 10 hospitalized children who underwent bronchoscopy and were diagnosed as TBTB and in the Department of Pediatrics of Peking University First Hospital and the Department of Pediatric Respiratory Medicine of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2011 to October 2019. The clinical characteristics of TBTB in children, and the efficacy and safety of bronchoscopy and transbronchial cryotherapy were summarized through descriptive analysis. Results: The onset age of 10 children (6 males and 4 females) ranged from 1-14 years. The clinical manifestations included fever (8/10), cough (7/10) and hemoptysis (2/10). Purified protein derivative test and interferon-γ release assay were performed in 9 and 10 patients respectively, the results were all positive. Chest CT examination was performed in all patients, and 8 patients had hilar and mediastinal lymphadenopathy. All patients underwent pediatric bronchoscopy in time, in 9 patients bronchus was found to be blocked in varying degrees by granulation tissue and caseous necrosis and in the remaining patient, obvious congestion and edema in bronchial mucosa. The bronchoscopic manifestations included 8 cases of lymph node fistula type, 1 case of granulation proliferative type and 1 case of inflammatory infiltration type. Pathological biopsies were performed in 7 cases, the findings were consistent with the pathological characteristics of tuberculosis. Nine patients were treated by pediatric bronchoscopic intervention, with 8 transbronchial cryotherapy by flexible bronchoscopy, and among them, 2 patients were treated by simultaneous rigid bronchoscopy. After 1-3 times of transbronchial cryotherapy, the blocked bronchial lumina in 8 cases were all recanalized, and the curative effect was significant without any serious complications. Conclusions: Bronchoscopy plays an important role in the diagnosis of TBTB in children and is helpful for its classification. Also, transbronchial cryotherapy has good efficacy and safety for TBTB in children, especially for the granuloproliferative type or lymph node fistula type.

Objectives: To study the quantitative and qualitative differences of visual evoked potential (VEP) in monocular visual impairment after different parts of visual pathway injury., Methods: A total of 91 subjects with monocular visual impairment caused by trauma were selected and divided into intraocular refractive media-injury group (eyeball injury group for short), optic nerve injury group, central nervous system injury and intracranial combined injury group according to the injury cause and anatomical segment. Pattern Reversal visual evoked potential (PR-VEP) P100 peak time and amplitude, Flash visual evoked potential (F-VEP) P2 peak time and amplitude were recorded respectively. SPSS 26.0 software was used to analyze the differences of quantitative (peak time and amplitude) and qualitative indexes (spatial frequency sweep-VEP acuity threshold, and abnormal waveform category and frequency) of the four groups., Results: Compared with healthy eyes, the PR-VEP P100 waveforms of the intraocular eyeball injury group and the F-VEP P2 waveforms of the optic nerve group showed significant differences in prolonged peak time and decreased amplitude in injured eyes ( P <0.05). The PR-VEP amplitudes of healthy eyes were lower than those of injured eyes at multiple spatial frequencies in central nervous system injury group and intracranial combined injury group ( P <0.05).The amplitude of PR-VEP in patients with visual impairment involving central injury was lower than that in patients with eye injury at multiple spatial frequencies. The frequency of VEP P waveforms reaching the threshold of the intraocular injury group and the optic nerve injury group were siginificantly different from the intracranial combined injury group, respectively( P <0.008 3), and the frequency of abnormal reduction of VEP amplitude of threshold were significantly different from the central nervous system injury group, respectively( P <0.008 3)., Conclusions: VEP can distinguish central injury from peripheral injury, eyeball injury from nerve injury in peripheral injury, but cannot distinguish simple intracranial injury from complex injury, which provides basic data and basis for further research on the location of visual impairment injury.

Portal hypertension treatment has always been regarded as complex and diverse. With the innovation of concepts and technologies, its treatment model has been transformed from a single-disciplinary diagnosis and treatment model to a multidisciplinary collaborative diagnosis and treatment model. In the multidisciplinary diagnosis and treatment model, the surgical treatment of portal hypertension is not a treatment that is about to disappear soon, but one of the indispensable treatment methods under the multidisciplinary diagnosis and treatment model, and it will play an increasingly important role. Surgeons should formulate individualized, standardized, and minimally invasive treatment methods under the input of new concepts, master the surgical indications and individualized surgical methods for different populations, and maximize the optimization surgical treatment methods for portal hypertension. Therefore, it is necessary to re-examine the role of surgical treatment in the diagnosis and treatment of liver cirrhotic portal hypertension.

In recent years, immunotherapy has achieved remarkable effectiveness for liver cancer and has attracted much attention, especially the combination therapy based on immune checkpoint blockers. Multidisciplinary experts have written the "Chinese multidisciplinary expert consensus on combined immunotherapy based on immune checkpoint inhibitors for hepatocellular carcinoma (2021 version)", which provides reference guidance for clinically relevant professionals to grasp indications, strengthen monitoring, timely and effective treatment of adverse reactions, and formulate reasonable combined treatment plan.

The clinical data of 22 patients with giant renal hamartoma in Zhejiang Provincial People's Hospital who underwent robot-assisted laparoscopic nephron-sparing surgery from October 2014 to January 2020 were retrospectively analyzed. All the patients successfully completed the operation. The operation time and renal artery occlusion time was (179±34) min and (19.8±2.5) min, respectively. The intraoperative blood loss was (117±62) ml, and the postoperative hospital stay was (9.0±1.5) d. All cases were confirmed as renal angiomyolipoma by postoperative pathology. No urine leakage, postoperative bleeding and other complications occurred. Postoperative telephone follow-up was performed for 6 to 52 months, and no tumor recurrence on the surgical side was reported.

Objective: To summarize and analyze the clinical characteristics of primary hyperpara-thyroidism (PHPT) with normocalcemic parathormone elevation (NPE) after surgical treatment, so as to improve the therapeutic ability and standardized post-operative follow-up of PHPT patients., Methods: Nine patients who were diagnosed with PHPT in the Department of Endocrinology of China-Japan Friendship Hospital from August 2017 to November 2019 were selected as the subjects. They all developed NPE within 6 months after surgical treatment. The clinical features and outcomes were collected and analyzed retrospectively, in addition, the related literature was reviewed., Results: Clinical features: among the 9 patients, 6 were middle-aged and elderly females and 3 were male. The main clinical manifestations were bone pain, kidney stones, nausea and fatigue except for one case of asymptomatic PHPT. Pre-operative examination showed high serum calcium [(3.33±0.48) mmol/L], low serum phosphorus [0.76 (0.74, 0.78) mmol/L], high 24-hour urinary calcium [8.1(7.8, 12.0) mmol/24 h], obviously elevated intact PTH [(546.1±257.7) ng/L], vitamin D deficiency [25-hydroxyvitamin D 3 (21.0±5.7) nmol/L]. Serum levels of bone alkaline phosphatase [7 patients 41.3(38.6, 68.4) μg/L, 2 patients >90 μg/L] and N-terminal midcourse osteocalcin (>71.4 μg/L) were significantly elevated. The estimated glomerular filtration rate decreased in 2 patients. Imaging examination: 7 patients had osteoporosis. Renal calculi were found in 3 patients by renal ultrasound. Imaging examination of parathyroid glands found definite lesions in all the patients, including 2 cases of multiple lesions and 7 cases of single lesions., Treatment and Outcome: two patients underwent parathyroidectomy, while other patients were treated with microwave thermal ablation. PTH increased 1 month after therapy [(255.0±101.4) ng/L], and no recurrent lesions were found by parathyroid ultrasound. After combined treatment with cal-cium and vitamin D for six months, PTH decreased significantly and the level of serum calcium remained normal at anytime during the follow-up period., Conclusion: The occurrence of postoperative NPE may be related to the higher pre-operative PTH, vitamin D deficiency and lower creatinine clearance. However, NPE may not predict recurrent hyperthyroidism or incomplete parathyroidectomy. Adequate calcium and vitamin D supplementation after surgery seems to be beneficial for patients with NPE. Post-operative follow-up of PHPT patients should be standardized to prevent and treat post-operative NPE.

Coptidis Rhizoma, as a bulk medicinal material, is in great demand in clinical practice. Its quality is uneven in the market due to the mixture of genuine, counterfeit and adulterants. Therefore, it is particularly important to establish a quality control system for Coptidis Rhizoma. Based on the concept of Chinese medicine quality marker(Q-marker), the potential quality markers of Coptidis Rhizoma were analyzed and predicted from the perspective of chemistry and pharmacology. The sources of the Q-markers of Coptidis Rhizoma were identified by literature retrieval. The potential Q-markers were then screened through the visualization of the &quot;components-targets-pathways&quot; network. High performance liquid chromatography(HPLC) was used to establish a multi-indicator qualitative and quantitative control method featuring fingerprints for 10 batches of Coptidis Rhizoma. A supervised mode of orthogonality partial least squares method-discriminant analysis(OPLS-DA) was used to screen the main marker components that caused differences between groups. The literature review results showed that the alkaloids were the main source of Coptidis Rhizoma Q-markers.The fingerprints of 13 common peaks were successfully established, and berberine, palmatine, berberine and epiberberine were selected as Q-markers of Coptidis Rhizoma, and their contents were determined.Based on the concept of the Q-marker of traditional Chinese medicine, the four components can be selected as the Q-marker of Coptidis Rhizoma after comprehensive consideration. The results of this study are not only conducive to the quality evaluation of Coptidis Rhizoma on the market, but also provide a reference for the overall quality control of Coptidis Rhizoma and lay foundation for the future exploration of the mechanism of Coptidis Rhizoma.

Nutrient resorption is an important strategy of nutrient conservation, which reflecting the ability of plants to conserve and utilize nutrients and adapt to environment. To explore the relationship between nutrient content and nutrient resorption of broadleaved woody species of different life forms ( i.e ., evergreen vs. deciduous), we sampled 30 broadleaved woody species in subtropical region of China located in Yangjifeng National Nature Reserve, Jiangxi Province. The nitrogen (N) and phosphorus (P) concentrations in green and senescent leaves of each species were measured to calculate nutrient resorption efficiency. Furthermore, we analyzed the relationship of leaf nutrient concentration and resorption efficiency for the different life forms. The results showed that N and P concentrations in green leaves were significantly higher in deciduous trees than those in evergreen trees. The P concentrations of senescent leaves in deciduous woody species was significantly higher than that in evergreen woody species. There was no significant difference of N concentration in senescent leaves between evergreen and deciduous species. Nitrogen resorption efficiency (NRE) and phosphorus resorption efficiency (PRE) of the 30 broadleaved woody species were 49.6% and 50.9%, respectively. There were no significant differences between the NRE and PRE of evergreen and deciduous species. NRE and PRE negatively correlated with N and P concentrations in senescent leaves, respectively. Additionally, evergreen and deciduous species showed similar relationships between nutrient resorption efficiency and nutrient concentration in senescent leaves. The sca-ling exponent of allometric relationship between NRE and PRE was 1.18 across all the species. The nutrient resorption efficiency of all the species were affected by the nutrient status of the senesced leaves. Plants examined in this study generally re-absorbed P from senescing leaves than N.

Objective: To evalutate the safety and efficacy of infrahepatic inferior vena cava clamping robot-assisted laparoscopic liver resection. Methods: All data about 24 patients with robotic liver resection at Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between February 2015 and December 2017 were collected and analyzed. These patients were divided into two groups based on different methods to decrease central venous pressure. Eight patients(6 males and 2 females,aged 49 years(range:50 to 56 years)) were applied with infrahepatic inferior vena cava clamping,and the other 16 matched cases (15 males and 1 female,aged 53 years(range:38 to 69 years)) were categorized into lowering central venous pressure group. Intraoperative blood loss,blood transfusion,intraoperative hemodynamic parameters,postoperative complications,and renal function were compared by t -test,non-parametric test,χ 2 test,or Fisher exact test. Results: There was significantly difference in the intraoperative blood loss between the infrahepatic vena cava clamping group and the lowering central venous group(200(220) ml (range:100 to 400 ml) vs. 750(800) ml (range:100 to 2 000 ml), Z =‒2.169, P =0.030). The clamping time of portal triad and infrahepatic inferior vena cava were 24 (18) minutes and 29 (20) minutes in the infrahepatic inferior vena cava clamping group, and portal triad clamping time was 23 (23) minutes in the low central venous group. There was no significant difference between the two groups ( Z =‒0.323, P =0.747). There was no intraoperative blood transfusion in the infrahepatic inferior vena cava clamping group, and 5 cases in the low central venous group, with a transfusion volume of 1.5(1.5)U. The difference between the two groups was statistically significant ( Z =‒3.353, P =0.001). However, the mean arterial pressure in the infrahepatic vena cava clamping group decreased from (88.6±4.9) mmHg to (67.4±3.8) mmHg(1 mmHg=0.133 kPa), which was lower than that of lowering central venous group (72.4±3.3) mmHg ( t =2.315, P =0.003). And there were no significant differences related to postoperative complications rate or hepatic and renal function in both groups. Conclusion: The infrahepatic inferior vena cava technology is safe and feasible to decrease central venous pressure during robotic liver resections,which will not affect the recovery of hepatic and renal functions.

Objective: To investigate the effect of GÖ6976 on the proliferation of chronic myeloid leukemia cells and its toxic effect on normal cells and mice, so as to provide experimental basis for the effectiveness and safety of its clinical application., Methods: Different concentrations of GÖ6976 were applied to the K562 cells, human peripheral blood mononuclear cells (PBMNC) and normal BaF3 cells, MTT assay was used to detect the effect on cell proliferation. BALB/C mice were used to investigate the toxicity in vivo. The general situation, body weight and the number of white blood cells in peripheral blood were monitored during administration, the blood collected from eyeballs before and after administration was used for biochemical examination, at the same time, the liver, kidney and femurs were examined pathologically., Results: GÖ6976 could significantly inhibit the proliferation of K562 cells, inhibition effect increased with increasing dose (r=0.9623). However, there was no significant change in the inhibitory effect on PBMNC and BaF3 cells. The pathological examination of organs in each group showed no abnormal manifestations such as inflammatory infiltration, while the change rate of leukocyte count in peripheral blood of high dose group fluctuated greatly (P＜0.05), which might be related to the inhibition of intracellular protein kinase C, and no abnormality was observed in blood biochemical indexes. In the low dose group, there was no significant difference in peripheral blood leukocyte count, blood biochemical index and histopathology during administration drug as compared with the control group., Conclusion: GÖ6976 possesses a significant inhibitory effect on the proliferation of K562 cells, and the inhibitory effect increases with increasing dose. Long-term application of 5.0 μmol/L and below concentrations of GÖ6976 shows no obvious inhibitory effect on PBMNC, BaF3 cells. Long-term application of 10 mg/kg and below concentrations of GÖ6976 shows no obvious toxic effect on BALB/c mice.

COVID-19 is a Public Health Emergency of International Concern (PHEIC). Direct economic loss is expected to be much more than that of SARS outbreak in 2003. The risk factors of COVID-19 epidemic at the early stage included the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions. The infection rate (or the incidence) reflects the prophylactic effect in population. Case fatality reflects the therapeutic effect of clinical intervention. There were sufficient medical resources at the national top levels accumulated in Wuhan. Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan. However, the case fatality in Wuhan has been kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, with limited effect in controlling this epidemic. The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic. The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China. Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of "attaching importance to clinical treatment and despising disease prophylaxis" , damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency. To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered. First, public health service, which should be fixed as the health section of the governments' public services by the law, must be greatly improved to meet the increasing health needs of the publics. Second, the vicious circle of profit-seeking-caused "attaching importance to clinical treatment and despising disease prophylaxis" should be immediately broken to optimize the national health service system in China by increasing the investment in public health service.

In the information age, teaching methods are undergoing tremendous changes, and the traditional teaching methods are difficult to draw students' attention. As the core course of stomatology, oral histopathology is an important foundation for oral students. Along with the rapid development of medical science, it is imperative to deepen the reform of teaching. This article discussed the diversified teaching methods conducted in oral histopathology course in Zhejiang University School of Stomatology in the past 10 years with the core teaching theory of "learning before teaching" including the exploration design course, case based learning, journal club, etc. Diversified teaching methods activated students' subjective initiative, which laid a foundation for the next stage of clinical study, and provided a guiding framework for the future teaching reforms.

To quantify the net greenhouse gas emissions (NGHGE) of typical open-field vegetables production in China and analyze potential mitigation measures, the life cycle assessment (LCA) method was used to calculate the agricultural inputs, carbon sequestration, and greenhouse gas emissions of open-field tomato, cucumber, Chinese cabbage, and radish production in China based on national statistical data. The results showed that greenhouse gas emissions of typical vegetable production in China were much higher than the associated carbon sequestration, suggesting that they were net greenhouse gas emitters. The weighted average net greenhouse gas emissions of open-field tomato, cucumber, Chinese cabbage, and radish production when expressed on an area basis were 4149, 3718, 3780, and 2427 kg·hm -2 (CO 2 -eq), respectively. The results from this study also indicated significant differences in the spatial distribution of greenhouse gas emissions for open-field vegetable production in China, and open-field tomato, cucumber, Chinese cabbage, and radish had higher greenhouse gas emissions in Hainan, Yunnan, Shaanxi, and Shandong, respectively, than in the other provinces. Fertilizer production, transportation, and application were the most significant contributors to the greenhouse gas emissions, contributing 86.8%-90.8% of the total emissions. This is significant for improving industry technology during fertilizer production and optimizing fertilizer management in open-field vegetable production based on different vegetables and provinces, which could achieve a double-win strategy in terms of increasing open-field vegetable yield and minimizing greenhouse gas emissions simultaneously.

Objective: To explore the disparities of hypertension control rate and its affecting factors between plateau and plain regions in Sichuan province., Methods: The cross-sectional study was conducted from May to September 2017. We recruited 231 subjects in Jinyang and Chenghua community health service center in Chengdu and 220 subjects in Jiulong County in Ganzi Autonomous Prefecture, Sichuan Province. Demographic characteristics, medical history, family history, lifestyle, cognitive function and medication compliance were collected using a structured questionnaire. Blood pressure and electrocardiogram were measured, and blood samples were collected among participants included in the study. Bivariate logistic regression analysis was used to investigate the affecting factors of hypertension control rate. All the statistical analyses were stratified by plateau and plain regions., Results: Hypertension control rate in the plain group was higher than the plateau group (19.05% vs. 8.64%). The logistic regression model showed that the control rate of hypertension was higher among the participants who were 70-80 years old than 40-50 years old in the plain group ( OR =4.037, 95% CI : 1.269-12.848). Central obesity ( OR =0.480, 95% CI : 0.233-0.987) and high uric acids ( OR =0.994, 95% CI : 0.989-0.998) were the risk factors of control rate. In the plateau group, high medication compliance ( OR =4.793, 95% CI : 1.407-16.326) and high uric acids ( OR =1.008, 95% CI : 1.003-1.012) were the protective factors, and low cognitive function ( OR =0.234,95% CI ：0.071-0.767) was risk factor., Conclusion: The control rate of hypertension in the plain is higher than that in the plateau. In the plain, the risk factors are central obesity and high uric acids, and aged 40-50 years. In the plateau, the risk factors are poor medication compliance and low cognitive function., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

The 2019 coronavirus disease(COVID-19) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the COVID-19 as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight against COVID-19.

Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.

Objective: To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen's pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD). Methods: Clinical data of 116 consecutive patients who underwent LPD using Chen's pancreaticojejunostomy technique in Hunan Provincial People's Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen's pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed. Results: All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes). The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2%(13/116) of cases had postoperative pancreatic fistula (POPF), including 10.3% (12/116) of biochemical fistula and 0.9%(1/116) of grade B POPF, no grade C POPF occurred; 10.3%(12/116) had gastrojejunal anastomotic bleeding; 3.4%(4/116) had hepaticojejunal anastomotic fistula; 3.4%(4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1%(14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7%(2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery. Conclusions: Chen's pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.

Abstract　　Chronic myelogenous leukemia (CML) is a hematological malignancy that seriously threatens the lives of patients. It was found that there are abnormal classic Wnt pathway, that is, Wnt/β-catenin signaling pathways in CML cells, moreover, Wnt/β-catenin signaling pathway is involved in the growth and proliferation of CML cells, and closely relates with the self-renewal ability of CML leukemic stem cells. This review summarizes the recent studies on the relationship between Wnt/β-catenin signaling pathway and CML, and the researches on the targeting inhibition of Wnt/β-catenin signaling pathway in CML treatment, thus to provide new ideas for the treatment of CML.

The five-year overall survival rate with liver cancer currently ranks the second lowest among seventeen common malignant tumors in China. The occurrence and development of liver cancer is a process of progressive exacerbation. Nowadays, the clinical research is mainly aimed at the intermediate stage, that is, the exploration of the principle and method of diagnosis and treatment in the hospital. Notably, the research on the precancerous stage and the recovery stage after treatment of liver cancer are still seriously inadequate. We put forward a stepwise strategy to emphasize that only the full course of prevention and treatment study on liver cancer patients can significantly improve the overall efficacy of liver cancer in China.

To investigate the effects of stem configuration on leaf biomass allocation in different organs of the current-year shoots at different canopy heights, relationships of biomass in different organs (i.e., leaves, stems, and twigs) and stem configuration (i.e., stem diameter, length, width/length, stem volume and stem density) were analyzed using the data of 69 woody species from the Yangjifeng Natural Reserve, Jiangxi Provence. Standardized major axis (SMA) was used to explore the regression between biomass and stem configuration. The results showed that there was no significant difference in leaf biomass, stem biomass, twig biomass, stem diameter, stem length, stem width/length and stem volume of current year shoots from upper and lower canopy heights and life forms (i.e., evergreen and deciduous woody plants). Stem density differed significantly in the current year shoots at different heights for both evergreen and deciduous woody species. There were isometric relationships among leaf, stem and total biomass of shoots in different canopy heights and in different life forms. Leaf biomass scaled allometrically with stem diameter and volume, with the scaling exponents being not different significantly among different canopy heights. With respect to the stem configuration of the twigs, stem length, stem width/length and stem density contributed less than 24% to the leaf biomass variation in the current-year shoots. On the contrary, stem diameter and volume had greater effects on leaf biomass of the current-year shoots than stem length, stem width/length and stem density. Canopy heights did not significantly affect the allometric scaling relationships between the stem configuration and leaf biomass of the current-year shoots.

Abstract　　At present, allogeneic hematopoietic stem cell transplantation is still the only way to cure chronic myelogenous leukemia. With the advances of HLA matching technology, application of tyrosine kinase inhibitors before and after transplantation, improvement of postoperative immune status and fusion gene monitoring, and the control of postoperative complications, especially graft-versus-host disease etc. allogeneic hematopoietic stem cell transplantation is displaying better efficacy in the treatment of chronic myelogenous leukemia, and the quality of life of patients has also been significantly improved. This article reviews the recent research advances on the allogeneic hematopoietic stem cell transplantation and related support technologies for treatment of chronic myeloid leukemia.

In the past 20 years,the advancement and breakthrough of applied basic research,the invention and renewal of medical devices,the popularization and improvement of minimally invasive techniques,the development and debate of innovative surgical methods and the establishment of the diagnosis and treatment standard brought the unprecedented development momentum to traditional liver surgery.This article combined the domestic and foreign related literature and the research results of our team. The current status and progress of the application of preoperative evaluation and surgical planning of liver surgery,surgical techniques of liver resection,laparoscopic and robotic techniques in liver surgery,enhanced recovery after surgery and associating liver partition and portal vein ligation for staged hepatectomy are briefly discussed.

Objective: To explore the clinical effect and safety of minor liver resection for hilar cholangiocarcinoma (HC) of Bismuth-Corlette type Ⅲ and Ⅳ. Methods: From May 2007 to May 2017, the clinical data of 108 patients with Bismuth-Corlette type Ⅲ and Ⅳ HC underwent hepatectomy were collected and analyzed retrospectively.There were 56 males and 52 females, aged (57.2±5.3) years (ranged 48-76 years) .Among the 108 cases, there were 51 cases of type Ⅲa, 40 cases of type Ⅲb and 17 cases of type Ⅳ. Small-scale hepatectomy (≤3 hepatectomy) was performed in 70 cases, including 8 cases of 4b segment resection, 28 cases of 4b segment+5 segment resection, and 34 cases of partial 4 segment+partial 7 segment+partial 1 segment resection. Large-scale hepatectomy was performed in 38 cases (>3 segments) , of which 30 cases were treated with 2 segments+3 segments+4 segments+1 segment, and 8 cases were treated with 5 segments+7 segments+8 segments+1 segment. t' test was used to analyze the data which did not conform to the normal distribution, and χ(2) test was used to calculate the incidence of postoperative complications and the 1, 3, and 5-year cumulative overall survival rate. Results: (1) The operation time of minor liver resection group ((180±25)minutes) was shorter than that of major liver resection group ((210±35)minutes) ( t' =4.676, P< 0.05) , the amount of blooding operation time of minor liver resection group ((310±80)ml) was less than that of major liver resection group ((500±110)ml)in the operation ( t' =9.385, P< 0.05) , and the difference was statistically significant. (2) The incidence of complications was lower in minor liver resection group and major liver resection group, and the difference was statistically significant (χ(2)=5.230, P< 0.05) . (3) The actual 1-, 3- and 5-year survival rates were 87.1%, 58.4%, 30.0% and 84.2%, 57.9%,31.6%, respectively. There were no significant differences in survival rates in two groups in 1-, 3- and 5-year survival rates (χ(2)=0.177, P= 0.674; χ(2)=0.005, P= 0.946; χ(2)=0.029, P= 0.865) . Conclusions: Compared to patients with major liver resection, Minor liver resection for selected patients with HC of Bismuth-Corlette Ⅲ and Ⅳaccording to our criteria achieved better long-term outcomes. Chen's biliojejunostomy is a simple, effective and safe method, which can be widely used when there are multiple biliary intestinal anastomosese.

Objective: To explore the effectiveness and safety of the combined treatment with acupuncture and venlafaxine hydrochloride on depression in terms of the microstructure change of white matter fiber tracts of brain based on diffusion tensor imaging technology (DTI)., Methods: The prospective study design was adopted. All of 60 patients with depression were randomized into an acupuncture-medication group and a medication group, 30 cases in each one. In the medication group, venlafaxine hydrochloride was used, 75 mg per day in the 1st week, 150 mg per day in the 2nd week and 225 mg per day from the 3rd to 6th week. In the acupuncture-medication group, on the base of the treatment in the medication group, acupuncture was combined. Baihui (GV 20) and Yintang (GV 29) were the main acupoints. The supplementary acupoints were selected according to the clinical symptoms of individuals. The needles were retained for 30 min. Acupuncture was provided once every 2 days, 3 times a week. The consecutive 12 weeks of treatment were required in the two groups. Additionally, a normal group was prepared with 30 healthy volunteers. Separately, before treatment, in 2, 8 and 12 weeks of treatment, Hamilton's depression scale (HAMD-17), Beck depression inventory scale (BDI) and the antidepressant side effect scale (SERS) were adopted to evaluate the effectiveness and safety of the two groups. Moreover, before and after 12 weeks of treatment, DTI was adopted to detect the fractional anisotropy score (FA) of each brain region in the patients., Results: After treatment, the scores of HAMD-17 and BDI were all reduced in the two groups ( P <0.05). In 8 and 12 weeks of treatment, the scores of HAMD-17 and BDI in the acupuncture-medication group were less than those in the medication group ( P <0.05). The difference in SERS score was not significant statistically between the two groups ( P >0.05). Compared with the healthy volunteers, FA scores in 6 brain regions changed obviously in the patients with depression, including the white matter of bilateral frontal lobes, splenium of corpus callosum, left cingulated gyrus, white matter of bilateral inferior temporal gyrus, white matter of bilateral inferior parietal lobe and white matter of bilateral deep temporal occipital region separately. Before treatment, the differences in FA scores of these 6 brain regions were not significant statistically between the two groups ( P >0.05). After treatment, FA scores in the white matter of bilateral frontal lobes, white matter of bilateral inferior temporal gyrus and white matter of bilateral deep temporal occipital region in the acupuncture-medication group were all higher than those in the medication group ( P <0.05)., Conclusion: Acupuncture repairs the brain white matter fiber tracts in some brain regions to certain extent and the therapeutic effects are enhanced with the adjuvant medication of venlafaxine hydrochloride.

Liver resection is the mainstay of treatment for patients with hepatocellular carcinoma (HCC). Most of HCC patients are associated with varied degrees of liver cirrhosis.Severity of liver cirrhosis adversely affects the outcomes of liver resection, and also plays a vital role in making an appropriate surgical strategy for HCC.In current surgical practice for HCC, liver function and functional reserve are the focus of preoperative evaluation. Liver cirrhosis is still widely regarded as an one-stage entity. The pathological severity of liver cirrhosis is largely ignored. As neither liver function nor functional reserve can reflect the pathological severity of liver cirrhosis when liver function is at the stage of compensation. Preoperative evaluation on the severity of cirrhosis has not been established in a surgical setting.Thus, there is an urgent need to stage the severity of cirrhosis in surgical practice in order to make more precise surgical modalities for individual patients.This article mainly introduces the ongoing research progress in staging the severity of liver cirrhosis while treating HCC at Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and emphasizes the importance of staging the severity of cirrhosis in surgical treatment of HCC.

Objective: To analyze the expression and relationship of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and kinase insert domain receptor (KDR) in local skin tissues of pressure injury and investigate the possible mechanism of stage 3 pressure injury refractory wound., Methods: Forty male SD rats were randomly divided into normal control group, compressed 3 d, 5 d, 7 d, and 9 d groups. Stage 3 pressure injury animal model were established by magnet compression. The morphology of skin was observed by HE staining. The expression of VEGF was detected by immunohistochemistry. The expression levels of HIF-1α, VEGF and KDR protein in skin tissue were detected by Western blot. One-way analysis of variance and LSD test were performed on the data., Results: ①The HE results showed that compared with the normal control group, the epidermis of the compressed group was gradually thickened, the number of blood vessels was decreased, the collagen arrangement disordered and inflammatory cells infiltration were increased. ②Immunohistochemical results showed that the expression of VEGF protein in the 3 d group was significantly higher than that in the normal control group (P＜0.01). The expression of VEGF protein in the skin tissue of 5 d, 7 d and 9 d groups was lower than that in normal control group (P＜0.05). WB results were consistent with immunohistochemistry results. ③WB results showed that the expression of HIF-1α in the skin tissues of the rats in 3 d, 5 d and 7 d groups was higher than that in the normal control group (P＜0.01 or P＜0.05). The expression of KDR protein was lower than that of the normal control group (P＜0.05 or P＜0.01)., Conclusion: HIF-1α mediated reduction of VEGF and KDR protein expression and decreased tissue angiogenesis may be one of the important causes of chronic dysfunction of stage 3 pressure injury.

Objective: To evaluate the efficacy and safety of low dose sublingual nifedipine dripping pills (5 mg) in treating moderate and severe hypertension in comparison with normal dose (10 mg) of sublingual nifedipine dripping pills. Methods: This study was designed as a randomized, double-blind, positive drug parallel controlled, multi-center, non-inferiority clinical trial. Patients with moderate and severe hypertension were enrolled by 14 clinical trial centers, randomly divided into the trial group (sublingual 5 mg nifedipine dripping pills) and the control group (sublingual 10 mg nifedipine dripping pills). The changes in blood pressure were monitored continuously within 2 hours after the initial administration, repeated the dose in 20 minutes interval after the initial administration for up to additional 3 doses (maximum 4 doses) if the antihypertensive efficacy was not satisfactory. The efficacy of antihypertensive therapy between the two groups was evaluated by repeated administration rates and blood pressure changes at 60 minutes post the initial administration, and the safety of treatment was evaluated by recording adverse event rate of the two groups. Results: The anti-hypertensive effective rates at 60 minutes after sublingual administration were 83.5% (202/242) and 86.7% (208/240) respectively between the trial group and control group (χ(2)=1.307, P= 0.253) . On the aspect of antihypertensive effectiveness at 60 minutes after single dose of sublingual administration, the anti-hypertension effective rates of the trial group and the control group were 85.6% (154/180) and 87.2% (164/188) respectively (χ(2)=0.221, P= 0.639). Prevalence of the repeated administration was also similar between the two groups (25.6%(62/242) in the trial group and 21.7% (52/240) in the control group, χ(2)=1.043, P= 0.307). On the safety aspect, there was no adverse events/reactions in the trial group, but there were 15 cases of adverse events/reactions occurred in control group (6.25%, χ(2)=15.611, P< 0.001). Conclusions: In the treatment of moderate to severe hypertension, the antihypertensive efficacy of low dose nifedipine dripping pills is similar to that of conventional dosage, and the safety profile of low dose nifedipine dripping pills is better than that of the conventional dose.

Objective: To study acoustic absorbance characteristics of wideband tympanometry in patients with unilateral Meniere's disease. Method: Acoustic absorbance were detected using wideband tympanometry in 36 patients with unilateral Meniere's disease and 39 control subjects excluding inner ear and middle ear disease. All patients with Meniere's disease underwent electrocochleography, gadolinium contrast internal auditory canal MRI, pure tone test. The integral area formed by the absorbance curve on peak pressure and x-axis(frequency) was calculated. Student's t -test was used to compare integral areas difference of 2 ears in Meniere's disease patients and control group. Result: The integral area of absorbance was greater in affected side than unaffected side and there was no difference in peak values of absorbance between 2 ears in Meniere's disease patients. There was no significant difference in areas between Meniere's disease in different grade( P >0.05). Peak value of absorbance and difference value of absorbance were not significant between Meniere's disease patients and normal control. Only 61.11% Meniere's disease patients showed -SP/AP＞0.4 and 95.24% showed endolymphatic hydrops in affected side. Conclusion: Affected side in patients with Meniere's disease showed higher integral area of absorbance than other side,which is high sensitive but not specific., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: This study was to analyze the results of video head impulse test (vHIT) of benign paroxysmal vertigo of childhood (BPVC) in order to determine the potential value of vHIT in the diagnosis and treatment for BPVC and to discuss its possible pathogenesis of BPVC. Method: Thirty-six children with BPVC were enrolled. No hearing loss and skull abnormality were found in these children as assessed by pure tone audiometry, acoustic impedance, CT or MRI scan. The vHIT was carried out, and main outcome measures were the gain of vestibulo-ocular reflex, gain asymmetry, and refixation saccades. Eleven healthy children were selected as normal control who came to our hospital for doing a routine checkup and have no history of dizziness. The differences of vHIT results between these two groups were analyzed. Result: ①The vHIT results in control group were normal. In all BPVC subjects, abnormalities were detected in 9 patients (25.0%),including vHIT gains decline in 3 patients, abnormal symmetry in 4 patients, and abnormal isolated overt saccades in 2 patients.②The average saccadic gain in different canals of BPVC group was 1.03±0.14, 1.01±0.15, 1.13±0.31, 1.18±0.36, 1.21±0.33, 1.14±0.30 in left horizontal, right horizontal, left anterior, right posterior, right anterior, left posterior canal, respectively; while in normal group, it was 1.14±0.15, 1.18±0.09, 1.16±0.30, 1.18±0.40, 1.34±0.26, 1.30±0.20, respectively. Significant statistical difference was found only in horizontal canals between these two groups ( P <0.05). ③Asymmetry of the three pairs of conjugated semicircular canals was 0.04±0.07 (horizontal canal), 0.06±0.04 (left anterior and right posterior canal), 0.06±0.04 (right anterior and left posterior canal) in BPVC group, respectively; while in control group, it was 0.02±0.02, 0.04±0.03, 0.04±0.04,respectively. There was no statistical difference between the two groups ( P >0.05). Conclusion: A certain proportion of abnormal peripheral vestibule function in children with BPVC was found. vHIT is a "child friendly," relatively easytouse, and simple tool to evaluate each of the 6 semicircular canals, which may offer some potential clinical information for assessing the vestibule dysfunction for BPVC., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To analyze the advantages and application value of tinnitus multielement integration sound therapy(T-MIST) in the diagnosis and treatment of tinnitus. Method: Collect 172 patients with subjective tinnitus and 54 non-tinnitus subjects, record history through T-MIST, observe the distribution of the tinnitus patients, an illness population characteristics, precise detection in patients with tinnitus related status indicators and analysis of gender, age, hearing loss, and the correlation of frequency of hearing loss and tinnitus, at the same time in surgical treatment and analysis of its curative effect. Result: The incidence of hypertension, sleep disturbance, diabetes, chronic noise exposure, rhinitis, colds and cervical spondylosis during tinnitus was high, and the frequency of tinnitus and hearing loss were high. There was no statistically significant difference between tinnitus and gender, age and hearing loss( P >0.05). As for the bivariate correlation analysis of tinnitus frequency and hearing loss frequency, tinnitus frequencywas positively correlated with hearing loss frequency( r =0.545). The effective rate of acoustic T-MIST treatment was 64.5%. Conclusion: T-MIST can record the patients' medical history synchronously, accurately detect their tinnitus and hearing condition, and conduct targeted treatment, which is more comprehensive and accurate than traditional treatment.., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

To investigate the trade-off between the twig size and leaf size, we measured the total leaf mass, stem mass, individual leaf mass and leafing intensity of typical bamboo&rsquo;s (Phyllostachys edulis, Indocalamus tessellatus, Oligostachyum oedogonatume, Yushania hirticaulis and Yushania wuyishanensis) twigs at different altitudes in Wuyi Mountain. The results showed that the exponents of the scaling between total leaf mass and stem mass on twigs significantly decreased with increasing altitude for all the five bamboo species. The common scaling exponents of total leaf mass vs. stem mass for P. edulis, I. tessellatus and O. oedogonatum were 0.94, 0.85 and 0.84, respectively. A common slope of 0.79 was observed in total leaf mass vs. stem mass in Y. hirticaulis and Y. wuyishanensis. There was significant negative correlation between individual leaf mass and leafing intensity among bamboo species, except Y. wuyishanensis. A common slope of -1.12 existed between individual leaf mass and leafing intensity for five bamboo species. In conclusion, bamboos at low altitudes tended to support more leaf biomass while preferring to invest more to stem biomass at high altitudes. Although the stem mass investment of different bamboo&rsquo;s twig increased with altitude, the leafing intensity strategies based on stem mass were determined by the leaf size construction rather than altitude.

Objective: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA. Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 ( n = 153) or 96 weeks ( n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281. Results: At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss. Conclusion: Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.

Objective: To explore the detection approach and aetiology of single-side deafness(SSD) in children and provide evidence for diagnoses and treatment. Method: A retrospective study was performed. Medical history and radiological data of children with unilateral deafness were analyzed. Result: The mean age at diagnosis was 6 years old. The mean age at diagnosis was 7.7 month because of failure of universal newborn hearing screening. Inner ear malformations were identified in 80.6% of cases. Cochlear nerve deficiency(CND) was observed in almost 77.8% of our cases, accounts for 96.6% in children with inner ear malformations. Conclusion: The children with SSD could be early detected by UNHS. CND is the main aetiology for SSD. MRI should be the first image choice when SSD children was diagnosed., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Using the eddy covariance technique, the Bowen-ratio meteorological and soil monitoring system, we analyzed the CO 2 flux dynamics and its responses to temperature and moisture over a meadow wetland in the Horqin during the growing season (from May to September) in 2016. The results showed that the accumulated net ecosystem CO 2 exchange (NEE) was -766.18 g CO 2 ·m -2 during the growing season. The gross primary productivity (GPP) and ecosystem respiration (R e ) were 3379.89 and 2613.71 g CO 2 ·m -2 , respectively. The ratio of R e to GPP was 77.3%, indicating that this ecosystem was an obvious carbon sink. The average diurnal variation of NEE exhibited a single peak U-shaped curve with an absorption of CO 2 from May to mid August and a release of CO 2 from late August to September. Daytime NEE well fitted with the photosynthetically active radiation (PAR) by a rectangular hyperbolic function. Meanwhile, the relationship was affected by the environmental factors, including vapor pressure deficit (VPD), soil water content (SWC) and air temperature (T a ). Regression analysis showed that the VPD and SWC for the maximum daytime NEE were 1.75 kPa and 35.5%, respectively. Daytime NEE increased with T a , and with no inhibitory effect on the daytime NEE when it reached the maximum. Nighttime NEE had an exponential relationship with soil temperature (T s ). During the entire growing season, the temperature sensitivity of the ecosystem respiration (Q 10 ) was 2.4, which was negatively related to SWC. The nighttime NEE was controlled by both T s and SWC.

Objective: To investigate the sleep quality and related determinants among centenarians in Hainan. Methods: A cross-sectional study of centenarians from 16 cities/counties was carried out in Hainan province between June 2014 and June 2016. Data related to demography, chronic diseases and lifestyles of the centenarians were collected. Pittsburg sleep quality index (PSQI) was used to assess the quality of sleep while multivariable logistic Regression model was used to determine the risk factors on the quality of sleep. Results: Of the 730 centenarians in this study, 225 suffered from sleep disorders (30.8%). The average score of PSQI was (6.44±3.05), with the top three problems related to sleep as sleep inefficiency (48.5%), sleep latency (35.5%), and daytime dysfuntion (20.6%) among the centenarians. Results from the multivariate logistic analysis showed that incontinence, cardiovascular disease and chronic pain were risk factors, while habitual afternoon nap, and regular diet appeared as protective factors ( P <0.05), related to sleep disorder. Conclusions: Quality of sleep had been a problem to the centenarians in Hainan. Intervention on risk factors of sleep disorder should be helpful on these centenarians.

Objective: To investigate the self-rated health and related factors in centenarians in Hainan province. Methods: A cross-sectional study in centenarians from 18 cities and counties was carried out in Hainan between June 2014 and December 2016. They data about their demographics, chronic diseases, ability of daily life, mental health and sleep quality were collected in a household interview. Self-rated health status was classified into 5 degrees according to the subjective assessment by centenarians. Results: Of 991 centenarians in this study, 157 (15.8%) were in good self-rated health and 228 (23.0%) were in poor self-rated health. Multivariate logistic regression analysis showed that chronic pain, visual impairment, depression, limited ability of daily life and poor sleep quality were the factors associated with poor self-rated health in centenarians in Hainan ( P <0.05). Conclusion: The proportion of centenarians in good self-rated health was low in Hainan, the influencing factors included chronic pain, visual impairment, depression, poor sleep quality and limited ability of daily life. It is necessary to conduct targeted intervention in centenarians in Hainan.