Objective To discuss the clinical value of high -quality nursing care in patients with diabetic ne-phropathy .Methods 160 patients with diabetic nephropathy were randomly divided into intervention group and control group, 80 cases in each group .The two groups were received the regular treatment and nursing care of diabetic ne-phropathy, while the intervention group further received high -quality nursing measures.The blood glucose, blood lip-id, renal function, oxidative stress index and SAS score were observed after 6 months.Results The blood glucose, blood lipid, renal function and SAS score index were significantly lower than the control group (p<0.05), and the oxi-dative stress index were improved significantly than that in the control group (p<0.05);Conclusion High-quality nursing intervention can obviously improve the psychological status and therapeutic effect of diabetic nephropathy .

Objective To study the relationship between personality and defense mechanism of obsessivecompulsive disorder (OCD) patients.Methods Thirty-four OCD patients were tested with Swedish University Scales of Personality(SSP) and defensive style questionnaire( DSQ), and the result was compared with that of thirty-one normal controls.Results The SSP scores of STA,PsTA,SS,E,TI and M of OCD patients were significantly higher than that of normal controls (t = 2.06 ～ 5.10, P ＜ 0.05 ).Comparing with normal controls, OCD patients tended to use immature and intermediate mechanism such as projection, passive aggression, unconscious emerge, phantasy, withdrawl and reaction formation, but less used mature mechanism such as sublimation, suppression and humor (t = -2.27 ～ 6.73, P＜ 0.05 ).All subscales of SSP in OCD patients, excluding SD and D, had positive correlation with total score of immature mechanism (r = 0.375 ～ 0.719, P ＜ 0.05 ).The OCD patients' SSP scores of STA had positive correlation with mature mechanism (r = 0.378, P ＜ 0.05 ).The OCD patients' STA, PsTA, I, AS, E, M,VTA and PhTA score of SSP had positive correlation with intermediate mechanism (r= 0.381 ～0.548, P＜ 0.05 ).All subscales of SSP in OCD patients, excluding SD, had positive correlation with total score of concealment (r =0.342 ～ 0.530, P ＜ 0.05 ).Conclusion OCD patients have the neurotic and aggressive features of personality;and the personalities of OCD patients have significant correlation with defense mechanism.

Objective：To explore the distribution of personality disorder tendency of outpatients in psychological counseling departments.Methods：Systematic sampling was used to get the sample population from Shanghai Psychological Counseling Center.The Personality Diagnostic Questionnaire(PDQ~(+4))was administered to 1402 clients to screen personality disorders.Results：The subscales for different type of personality disorder(PD)and total score of PDQ~(+4) were higher than normal sample(e.g.total score of PDQ~(+4):client(38.23±17.04)vs.normal sample(22.79±14.10),P<0.001).The score of borderline subscales in female clients were higher than that of males [borderline:female(4.25±2.48)vs.male(3.97±2.41),P<0.05],the score of antisocial,paranoid and schizotypal subscales in male clients were higher than that of females [antisocial:female(1.31)vs.male(1.71),P<0.001;paranoid:female(2.75)vs.male(3.02),P<0.01;schizotypal:female(3.31)vs.male(3.56),P<0.05].Age stratification showed that the subscales for different type of PD of PDQ~(+4) were decreased with age [e.g.,total score of PDQ~(+4):18～24 years(41.73)vs.25～34 years(39.46)vs.35～44 years(33.88)vs.≥ 45 years(30.64),Ps<0.001],the positive rate of PDQ~(+4) subscales of obsessive-compulsive(58.5%)and avoidant PDs(54.0%)were higher than others,followed by borderline PD(44.4%).Factor analysis was used for the score of PDQ~(+4),factor 1 to 3 corresponded to cluster C,B and A personality disorders respectively,and the total variance explained 67%. Conclusion：There are different rates of personality deviation between psychological counseling clients and normal sample in China.Some traits of personality disorders can be improved with the increasing of age.The abstracted factors by factor analysis are very consistent with what originally proposed in the theory of personality disorder.It should be paid attention to PD tendency of clients during psychological counseling.

Objective To investigate the relationship between the characteristics of psychological defense style and clinical symptoms of eating attitude in patients with anorexia nervosa patients. Methods Totally 92 ca?ses ( 46 cases of restricting type,46 cases of binge?eating/purging type,48 cases of early onset before 16 years old, 44 cases of late onset after 16 years old) meeting the Diagnostic and Statistical Manual of Mental Disorders,Forth Edition ( DSM?4) for anorexia nervosa (AN) were collected.92 gender?marriage?and education?matched normal cases in a psychiatric hospital were selected as the healthy control group(HC) .All were assessed with defensive style questionnaire(DSQ) and eating attitude test?26(EAT?26).DSQ and EAT?26 were compared between AN and HC,between early onset of AN( before 16 old years) and late onset of AN( after 16 old years) ,and between AN?R and AN?P.Then correlation study was done for the AN. Results Compared with HC,AN showed higher scores in the immature defense,neurotic defense ((4.49±1.13)vs (3.55±0.93),(4.33±0.76)vs (3.88±0.69), P<0.001), and higher EAT?26 median total and factor scores of dieting scale items,bulimia&food preoccupation scale items, oral control subscale items (P<0.01).Compared with AN?R,AN?P showed higher scores in the immature defense ((4.49±1.03)vs (4.79±1.13), P=0.01),and higher EAT?26 median total and factor score of bulimia&food pre?occupation scale items (P<0.05, P<0.01).The correlations between immature defense and EAT?26 total score,be?tween neurotic defense and EAT?26 total score were significant( r=0.472, P<0.001;r=0.315, P=0.002). The correlations between immature defense and EAT?26 dieting score, between neurotic defense and EAT?26 dieting score were significant( r=0.343, P<0.001, r=0.257, P=0.014).The correlations between immature defense and EAT?26 bulimia & food preoccupation score,between neurotic defense and EAT?26 bulimia & food preoccupation score were significant( r=0.523, P<0.001, r=0.267, P=0.010).The correlations between immature defense and duration were significant( r=0.375, P<0.001).The correlations between all defense factors and BMI were not sig?nificant( r=-0.15?0.25, P>0.05) . Conclusion AN patients tend to use more immature defense and neurotic de?fense compared with HC,and AN?P patients use more immature defense compared with AN?R. Immature defense and neurotic defense are related to the eating attitude,and the immature defense is related the duration.

Objective:To observe the therapeutic effect of echinacoside (ECH) on liver injury and glucose metabolism disorder in sepsis rats induced by cecal ligation and puncture (CLP), and to explore its possible mechanism.Methods:Forty eight male Sprague Dawley (SD) rats were randomly divided into four groups: sham group (sham), model group (CLP), treatment group (CLP+ ECH) and inhibitor group (CLP+ ECH+ EX527). The sham group only received laparotomy, and the model group underwent CLP. The treatment group was intragastric administration of echinacea (30 mg/kg) every day after CLP modeling. The inhibitor group was injected with silence information regulator 1 (SIRT1) inhibitor EX527 (5 mg/kg) one hour before CLP, and then treated the same as the treatment group. Fasting blood glucose, insulin and serum biochemical indexes were detected in virous groups. The serum levels of interleukin (IL)-1 β, IL-6 and tumor necrosis factor-α(TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). 2′, 7′- dichlorofluorescein diacetate (DCFH-DA) staining was used to observe the production of reactive oxygen species (ROS) in liver tissue of rats in each group; hematoxylin-eosin (HE) staining was used to observe the pathological changes of liver tissue in each group; The expressions of SIRT1, glucose-6-phosphatase (G6Pase), phosphoenolpyruvate carboxykinase (PEPCK), phosphorylated signal transducers and activators of transcription 3 (p-STAT3) and phosphorylated protein ki-nase B(p-AKT) were detected by Western blot.Results:Compared with sham group, the levels of serum glucose, serum insulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), ROS, IL-1β, IL-6 and TNF-α in model group increased, while the liver glycogen and survival rate decreased (all P<0.05). After echinacoside treatment, the serum glucose, serum insulin, ALT, AST, ROS , IL-1β, IL-6 and TNF-α levels decreased, and the liver glycogen and survival rate increased (all P<0.05); After SIRT1 inhibitor intervention, the levels of serum insulin, ALT, AST, IL-6 and ROS in the inhibitor group increased ( P<0.05). HE staining showed that there were infiltration and necrosis of inflammatory cells in the liver tissue of model group, and echinacoside could significantly reduce the focal and massive necrosis; Western blot showed that compared with the sham group, the expression levels of SIRT1, p-STAT3 and p-AKT protein in the model group decreased, while the expression levels of G6Pase and PEPCK protein increased ( P<0.05); After echinacoside treatment, the expression levels of SIRT1, p-STAT3 and p-AKT increased, while the expression levels of G6Pase and PEPCK decreased ( P<0.05). After SIRT1 inhibitor intervention, the expression of SIRT1, p-STAT3 and p-AKT protein decreased, and the expression of G6Pase and PEPCK protein increased in the inhibitor group ( P<0.05). Conclusions:Echinacoside is a potential therapeutic agent for sepsis associated liver injury and glucose metabolism disorders, which may play a role by targeting SIRT1 to activate STAT3 and AKT in the liver.

Objective:To investigate whether miRNA-296-5p can inhibit enterovirus 71 (EV71) virus replication in neural cells SK-N-SH by targeting the phosphatase and tensin homology deleted on chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/serine/threonine kinases (AKT) signaling pathway.Methods:Serum samples were collected from patients with EV71 virus-infected hand-foot-mouth disease and normal physical examination, and the expressions of serum inflammatory factors procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6), IL-1β, and IL-13 were detected by enzymelinked immunosorbent assay (ELISA). Human neuroblastoma SK-N-SH cells infected by EV71 virus in logarithmic growth phase were set up as control group, miRNA-296-5p mimic group and miRNA-296-5p inhibitor group. The transfection was carried out according to the Lipofectamine 2000tm cell transfection reagent. The expression of EV71-VP1 gene mRNA and protein and PTEN/PI3K/Akt signal pathway related molecules in three groups of cells was observed by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and Western blot.Results:ELISA test results showed that the levels of serum inflammatory factors PCT, CRP, TNF-α, IL-1β, IL-6 and IL-13 in patients with EV71 virus-infected hand, foot and mouth disease were significantly higher than those in normal physical examination ( P<0.05). The results of qRT-PCR and Western blot showed that the mRNA and protein levels of mirna-296-5p and PTEN in SK-N-SH were significantly decreased after EV71 virus infection, while the mRNA and protein levels of EV71-VP1 and molecules related to PI3K/AKT signaling pathway were significantly increased ( P<0.05). The expression of PTEN was significantly increased in the miRNA-296-5p mimic group, and the expression of EV71-VP1 and the activation of the PI3K/AKT signaling pathway were inhibited, while the effect was reversed in the miRNA-296-5p inhibitor group ( P<0.05). Conclusions:MiRNA-296-5p inhibits the replication of EV71 virus in neural cells SK-N-SH by targeting the PTEN/PI3K/AKT signaling pathway, while reducing the cellular inflammatory response, targeting miRNA-296-5p and downstream PTEN/PI3K/AKT The signal pathway is expected to provide therapeutic targets and theoretical basis for the treatment of hand-foot-mouth disease caused by clinical EV71 virus.

Objective:To construct a value evaluation framework for high-value medical consumables,providing a guidance for medical insurance access and hospital access management scenarios in China.Methods:It conducted literature review,qualitative in-terviews and quantitative surveys.A total of 12 experts were invited for qualitative interviews,while 100 experts from four fields of health technology assessment,medical insurance,hospital management,and clinical practice participated in the quantitative survey.Through those process,it generated the composition of the value framework and the scoring of each item.Differences in ratings be-tween different scenarios and experts were analyzed through chi-square tests.The recommendation level for each item was graded.Re-sults:A comprehensive value evaluation framework for high-value medical consumables was established,which included 6 core dimen-sions,comprised 16 items for secondary dimensions and 50 items for tertiary dimensions.It showed significant differences between the medical insurance access and hospital access scenarios,as well as among different fields of experts in the same scenario.furthermore,grading the items in two scenarios.The medical insurance access scenario had 8 highly recommended items,and the hospital access scenario had 24 highly recommended items.Conclusion:Value evaluation should encourage multi-dimensional assessments and inter-disciplinary participation,continually improving the management of high-value medical consumables in medical insurance and hospital access.

Many efforts have been made to understand excitotoxicity and develop neuroprotectants for the therapy of ischemic stroke. The narrow treatment time window is still to be solved. Given that the ischemic core expanded over days, treatment with an extended time window is anticipated. Bestrophin 1 (BEST1) belongs to a bestrophin family of calcium-activated chloride channels. We revealed an increase in neuronal BEST1 expression and function within the peri-infarct from 8 to 48 h after ischemic stroke in mice. Interfering the protein expression or inhibiting the channel function of BEST1 by genetic manipulation displayed neuroprotective effects and improved motor functional deficits. Using electrophysiological recordings, we demonstrated that extrasynaptic glutamate release through BEST1 channel resulted in delayed excitotoxicity. Finally, we confirmed the therapeutic efficacy of pharmacological inhibition of BEST1 during 6-72 h post-ischemia in rodents. This delayed treatment prevented the expansion of infarct volume and the exacerbation of neurological functions. Our study identifies the glutamate-releasing BEST1 channel as a potential therapeutic target against ischemic stroke with a wide time window.