Objective To investigate the abnormal brain activity of first-episode depression by rest-ing state functional magnetic resonance imaging ( fMRI) .Methods Twenty-one adolescent participants diag-nosed with depression(AD) and 18 healthy controls ( HC) were recruited.Resting state fMRI brain scans were performed on all participants.Regional homogeneity ( ReHo) approach was applied to preprocess the fMRI datasets.The value of ReHo maps were obtained in the whole brain.Results ReHo values in the AD group were higher than those in the healthy controls in the right inferior temporal gyrus ( MINI:66,-24,-20) ,left upper cingulate cortex (-27,47,-6) ,frontal polar (-24,59,14) ,after upper left cingulate cortex (-1,-16,35),after the bottom left cingulate cortex (-2,-38,32),left praecuneus (-1,-48,65) com-pared with that in the healthy controls (P<0.05) .ReHo in the AD group decreased in the right middle tempo-ral gyrus (45,-34,32) compared with that in the healthy controls (P<0.05).Conclusion Extensive ReHo abnormalities were found in the brains of patients with first-episode,drug-naive depression,and these abnor-malities in spontaneous neural activity may contribute to the neuropathology of adolescent depression.

Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.

Objective:To analyze the clinical, neurophysiological and genetic features of CHRNB1 gene mutations-related congenital myasthenic syndromes (CMS), and to facilitate the recognition and differential diagnosis of this disorder.Methods:The clinical characteristics and laboratory features of the proband in a family with CHRNB1 gene mutations-related CMS were recorded, and the neurophysiological testing and high-throughput sequencing for the proband were performed. In addition, the response to the treatment and prognosis of the proband were reported.Results:The proband is a 16-year-old female who had bilateral eyelid ptosis at the age of 4, presented with limb weakness at the age of 12. Her father has the similar symptoms and other family members are not affected similarly. Serum creatine kinase and thyroid function were normal. Needle electromyography results demonstrated no myopathic disorders. All myasthenia gravis-related antibodies tests including anti-acetylcholine receptor antibody were negative and she failed to respond to pyridostigmine. There was a decremental response of the compound muscular action potential on 5 Hz repetitive nerve stimulation. Brain magnetic resonance imaging and chest CT were unremarkable. The proband was found a heterozygous mutation (c.865G>A (NM_000747)) in CHRNB1 gene exon 8 through high throughput sequencing. She started a 60 mg/d treatment of fluoxetine and showed beneficial response at one-year follow-up.Conclusions:The clinical presentation of CHRNB1 gene mutation-related slow-channel CMS is similar to autoimmune myasthenia gravis, and is likely to be misdiagnosed. High-throughput sequencing accelerates the diagnosis.

Objective To analyze the level of self-management and its influencing factors among patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 129 patients with NAFLD were recruited using convenience sampling method as study participants. A questionnaire survey was conducted among these patients using general information questionnaire, self-management scale, and health behavior competence scale. Multivariate linear regression analysis was employed to identify the factors influencing the level of self-management among NAFLD patients. Results The overall score of the self-management scale among NAFLD patients was (77.60±21.68). A positive correlation was observed between various dimensions of health behavior score and self-management score (P < 0.05). Monthly income, exercise frequency, dietary habits and mental health status were identified as significant influencing factors of self-management level among NAFLD patients (P < 0.05). Conclusion The self-management level of NAFLD patients is moderate and is influenced by their monthly income, exercise habits, dietary habits and mental health status. Healthcare professionals should develop targeted intervention programs addressing these factors to enhance patients' self-management capabilities.

Objective Polysaccharide is a major active component in Lycium barbarum.the structure and content of polysaccharide are different among different producing districts.At present,most of the quality control methods of Lycium barbarum polysaccharide construct fingerprint from the aspect of monosaccharide composition,but the quality control of Lycium barbarum polysaccharide only by analyzing monosaccharide composition can not fully explain the relationship between structure and Lycium barbarum polysaccharide.Therefore,we established the Needs methylation method of Lycium barbarum polysaccharide fingerprint to achieve quality control of Lycium barbarum from different places by determining the sugar residue linkage mode of Lycium barbarum polysaccharide on the basis of monosaccharide composition.Methods Lycium barbarum polysaccharide was extracted through water extraction followed by alcohol precipitation,and the Needs methylation,complete acid hydrolysis,reduction by NaBH4,acetylation and other methods combined with GC-MS to determine the sugar residue linkage motif of Lycium barbarum polysaccharide.Result The chromatograms of 18 batches of Lycium barbarum polysaccharides were imported into the Chinese Medicine Chromatographic Fingerprint Similarity Evaluation System(2004 edition),combined with chemometrics to evaluate the differences of Lycium barbarum polysaccharide from different origin.The result of similarity showed that the similarity of three batches of Lycium barbarum polysaccharide from Tibet ranged from 0.551 to 0.569,others were more than 0.929.16 common peaks were marked in chromatogram of sugar residue linkage mode,and 10 of them was identified,they are T-Arap,T-Araf,T-Xylp,1,2-Arap,1,3-Rhap,1,5-Araf,T-Glcp,T-Galp,1,4-Glcp,1,6-Galp.The results of HCA,PCA and PLS-DA analysis divided 18 bathes of Lycium barbarum polysaccharide were divided into three categories,and three signature components were screened,which were T-Araf,1,5-Araf and T-Glcp,to judge the differences of Lycium barbarum polysaccharides from different places.Conclusion The Needs methylation fingerprint of 18 batches of Lycium barbarum polysaccharide was established for the first time.The establishment of the fingerprint can provide experimental data reference for the quality control of Lycium barbarum polysaccharide,and further prove the role of polysaccharide in the quality control of Traditional Chinese Medicine.

Objective To explore the application effect of health-care failure mode and effect analysis (HFMEA) in infection control among hemodialysis patients.Methods In October 2014,Northern Jiangsu People′s Hospital hemodialysis unit established a management group for HFMEA. We assessed the susceptible failure of hemodialysis patients and analyzed the causes to propose corrective measures. We compared the control group and the intervention group in following aspects:the occurrence of infection (vascular access infection, respiratory infection,urinary system infection and other infections),risk priority number (RPN) of HFMEA and patient′s satisfaction.Results The incidence rate of infection in hemodialysis patients was significantly decreased after the application of HFMEA mode. RPN value of failure mode easy to cause infection dropped to 605 points′s from 1470 points,and the total scores reduced by 58.8%;the patient′s satisfaction increased from (81.31±6.74) to (91.70±5.02)(t=23.935,P<0.05).Conclusions By using HFMEA mode,the failure can be forecasted in hemodialysis procedure and the potential danger can be quantized through RPN. In addition, the projects that need to be focusd on can be identified. So as to effectively reduce the incidence of infection in hemodialysis patients and improve patient′s satisfaction.

Objective To summarize the clinical,electrophysiological profile and prognosis in paraneoplastic syndrome with SRY-like high-mobility group superfamily of developmental transcription factors (SOX) 1 antibody.Methods The clinical profile,laboratory examination,electrophysiology,tumor,treatment and prognosis of three patients of paraneoplastic syndrome with SOX1 antibody in Tangdu Hospital,Air Force Military Medical University from 2016 to 2018 were retrospectively analyzed.Results Proximal lower limbs weakness was the first symptom in all the three patients,weakness normally spreading proximally to distally,involving feet and hands,finally reaching the oculobulbar region,and dry mouth was the most common autonomic dysfunction.Compound muscle action potential (CMAP) amplitude was low in all the patients,and the CMAP amplitude became even lower at low stimulating frequencies.An increase in CMAP amplitude with high-frequency stimulation was found in two patients during the follow-up.Lambert-Eaton myasthenic syndrome (LEMS) and motor axonal peripheral neuropathy were considered.Acetylcholine receptors antibody was positive in one case and voltage-gated calcium channel antibody was positive in another case.Two cases were found complicated with small cell lung carcinoma,one case with small cell carcinoma of the esophagus.After treatment of intravenous immunoglobulin,chemotherapy and pyridostigmine,the prognosis of the patients was different.Conclusions SOX1 antibody as an antibody in paraneoplastic syndrome,is most common in small cell lung cancer with LEMS,sometimes with axonal peripheral neuropathy.LEMS needs to be considered when patients manifest proximal limb weakness and dry mouth,and screening for tumors is needed.

Objective To study the effect of rhBNP on serum chemerin and IL-37 levels in acute myocardial infarction (AMI) patients undergoing emergency PCI.Methods Eighty AMI patients who underwent emergency PCI were randomly divided into cortrol group (n =40) and rhBNP treatment group (n=40).The patients in control group were treated with conventional drugs and those in rhBNP treatment group were treated with intravenous rhBNP.Their serum chemerin and IL-37 levels were measured by ELISA.Their LVEDD and LVEF were compared.Results The serum level of chemerin was significantly lower while that of IL-37 was significantly higher in two groups at 72 h and on day 7 after PCI than before PCI (P＜0.05).The serum level of chemerin was significantly lower while that of IL-37 was significantly higher in rhBNP group than in control group at 72 h and on day 7 after PCI (P＜0.05).The LVEDD was significantly shorter while the LVEF was significantly higher in two groups on day 7 and month 1 after PCI than before PCI (P＜0.05).The LVEDD was significantly shorter in rhBNP group than in control group on day 7 and month 1 after PCI (P＜0.05).Conclusion rhBNP can effectively reduce the serum chemerin level,increase the serum IL-37 level,and improve the cardiac function in AMI patients following emergency PCI.The effect of rhBNP is better than that of conventional drugs in AMI patients after emergency PCI.

Objective:To investigate the diagnostic value of neutrophil CD64 index in sepsis patients in intensive care unit (ICU).Methods:A prospective case-control study was conducted, the patients admitted to ICU of Jiangbei People's Hospital Affiliated to Nantong University from December 2016 to June 2020 were enrolled. According to the criteria of Sepsis 3, 107 patients diagnosed with sepsis were classified as the sepsis group, 112 patients without infection were classified as control group. Peripheral venous blood samples were collected within 24 hours after ICU admission, neutrophil CD64 index, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC) were detected. Receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic value of neutrophil CD64 index, CRP, PCT and WBC for sepsis.Results:The neutrophil CD64 index, CRP and PCT in sepsis group were significantly higher than those in control group [neutrophil CD64 index: 9.03±5.59 vs. 3.18±1.50, CRP (mg/L): 146.9±68.3 vs. 46.5±35.8, PCT (ng/L): 31.82±14.71 vs. 1.87±1.42, all P < 0.05]. ROC curve analysis showed that neutrophil CD64 index, CRP and PCT had certain diagnostic value for sepsis, the area under ROC curve (AUC) were 0.924, 0.915 and 0.879, respectively, the 95% confidence intervals (95% CI) were 0.871-0.978, 0.855-0.975, 0.807-0.951, respectively, P values were 0.016, 0.017 and 0.026, respectively. Among the three indicators, the diagnostic value of neutrophil CD64 index was much higher. When the optimal cut-off value was 4.32, the sensitivity and specificity were 83.6% and 88.7%, respectively, which were higher than the sensitivity (75.1%, 76.3%) and specificity (87.2%, 82.5%) of CRP and PCT. Conclusion:Neutrophil CD64 index is a valuable biomarker for the diagnosis of sepsis in ICU.

Based on the research of current domestic medical service item and the financial classification policy,combined with the existing problem during the practice,it analyzes the existing problem of financial classification in medical service item cost,and discusses the proposal of nationwide unified mapping between medical service item and their financial classification,the practice path-way of implementation,it can be the valuable reference for hospital's refined financial management and payment reform.