ObjectiveTo evaluate the efficacy and safety of 7 atypical antipsychotics combined with selective serotonin reuptake inhibitors（SSRIs） in the treatment of refractory obsessive-compulsive disorder by network Meta-analysis. MethodsRandomized controlled trials （RCTs） about atypical antipsychotics and SSRIs in the treatment of refractory obsessive-compulsive disorder were searched in CNKI， Wanfang Data， VIP， CBM， PubMed， Embase and Cochrane Library databases from inception to June 2020. Based on inclusion and exclusion criteria， the literature screening， date extraction and assessing risk of bias were performed by two researchers independently. Then all statistical analyses were performed using Stata 15.0 software. ResultsA total of 36 RCTs covering 7 atypical antipsychotics and 2 362 patients were included. Network Meta-analysis showed that the surface under the cumulative ranking （SUCAR） of total response rate was the largest in Olanzapine + SSRIs， followed by Paliperidone + SSRIs， Amisulpride + SSRIs， Risperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Aripiprazole + SSRIs， SSRIs， and Placebo + SSRIs in turn. In terms of Hamilton Anxiety Scale （HAMA） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by Aripiprazole + SSRIs， Quetiapine + SSRIs， Risperidone + SSRIs， and SSRIs in turn. In terms of Treatment Emergent Symptom Scale （TESS） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by SSRIs， Paliperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Risperidone + SSRIs， Aripiprazole + SSRIs， and Placebo + SSRIs in turn. ConclusionCompared with single application of SSRIs， its combination with atypical antipsychotics achieves better efficacy and higher safety in treating refractory obsessive-compulsive disorder， with Olanzapine+SSRIs being the most effective and Amisulpride+SSRIs the safest.

Chronic pain is a worldwide public health problem in which neuropathic pain (NP) caused by nerve damage is the most common chronic pain. At present, NP lacks effective treatment for any reason. In recent years, increasing studies have shown that neuroimmunity and neuroinflammation play a key role in mediating NP, and nuclear factor-kappa B (NF-κB) plays the most important role in the expression of pain inducers and effectors in the immune and inflammatory systems. NF-κB promotes transcriptional up-regulation by a promoter that links to a variety of inflammatory factors. Therefore, this paper reviews the research status of the role of NF-κB in NP.

Objective To explore the temporal and spatial distribution characteristics of air pollutants PM_2.5, PM₁₀, SO₂, CO, and NO₂, and their effects on acute cerebrovascular diseases in Jining City. Methods The data of patients with acute cerebrovascular disease treated in a 3A hospital in Jining from October 1, 2017, to November 31, 2019, were retrospectively collected. Combined with the air pollution data of 29 air quality monitoring stations in Jining City, the Kriging interpolation model was used to analyze the overall situation of air pollution in Jining. On this basis, the relationship between air pollution and acute cerebrovascular diseases in Jining City was analyzed. Results In Jining City, the incidence of acute cerebrovascular disease in male was higher than that in female, and the incidence in rural areas was significantly higher than that in urban areas. The spatial distribution showed a trend of gradual accumulation from southeast to northwest. The daily average concentrations of PM2.5 and PM10 were higher in winter and spring than in summer and autumn. The results of Kriging interpolation analysis showed that the concentrations of these air pollutants formed aggregation points in varying degrees. The spatial distribution of acute cerebrovascular disease patients in Jining City was highly consistent with the spatial distribution of air pollutant concentrations. Spearman correlation analysis showed that CO, SO₂, and NO₂ were positively correlated with the incidence of acute cerebrovascular disease, while the correlation between PM_2.5 and PM₁₀ and the incidence of acute cerebrovascular disease was not significant. Conclusion Some air pollutants such as CO, SO₂, and NO₂ have a positive correlation with the incidence of acute cerebrovascular disease, and the prevalence has a certain population and regional distribution. In the future work of cerebrovascular disease prevention, personal protection should be done according to local conditions and living environment of specific people.

Objective To compare the efficacy of different volume of ropivacaine and lidocaine for ultrasound-guided infraclavicular brachial block.Methods Sixty patients scheduled for distal upper limb surgery were divided into group A and group B by random digits table method with 30 cases each.The patients were given ultrasound-guided infraclavicular brachial block,but the patients in group A using 0.3％ ropivacaine mixed with 1％ lidocaine 20 ml,the patients in group B using the same mixture 30 ml.Sensory block was assessed every 5 min after the block.Motor block was evaluated at 30 min after the block.The onset time of anesthesia,surgical success rate,complications and duration of anesthesia were recorded.Results There was no significant difference in the surgical success rate [93.3％(28/30) vs.96.7％(29/30),P＞0.05],onset time of sensory block [10 (5) min vs.5 (5) min,P＞0.05] and degree of motor block between the 2 groups.The duration of anesthesia in group A was shorter than that in group B (P ＜ 0.05).Conclusion The efficacy of ultrasound-guided infraclavicular brachial block with the mixture of 0.3％ ropivacaine and 1％ lidocaine 20 ml and 30 ml is similar in surgical success rate and onset time of anesthesia.

BackgroundThe incidence of cognitive impairment in patients with depressive disorder is high， and the causes and mechanisms of which deserve more attention. It is usual that the thyroid hormone levels in patients with depressive disorder alter. Further research is needed to explore whether the cognitive function changes in patients with depressive disorder are related to thyroid hormone levels. ObjectiveTo explore the improvement of cognitive function in patients with first-episode depressive disorder after escitalopram and paroxetine treatment， and to analyse its correlation with thyroid hormone levels， so as to look for potential biomarkers of cognitive function change in patients with depressive disorder. MethodsFrom March 2021 to March 2022， 120 patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） for depression and were hospitalized at Shandong Mental Health Center were selected as the research objects. They were randomly divided into two groups by random number table method with 60 patients in each group. The two groups were treated with escitalopram （starting dose 5 mg/d） and paroxetine （starting dose 20 mg/d） for 6 weeks. Before and 6 weeks after the treatment， levels of thyroid stimulating hormone （TSH）， free thyroxine （FT4） and free triiodothyronine （FT3） were tested respectively. Depression degree and cognitive function level were assessed using the Hamilton Depression Scale-17 item （HAMD-17） and Montreal Cognitive Assessment （MoCA）， respectively. Pearson or Spearman correlation analysis was used to examine the correlation between the MoCA score difference before and after the treatment and the post-treatment level of thyroid hormone. ResultsBefore and 6 weeks after the treatment， the time effect of HAMD-17 total score in both groups was statistically significant （F=1 236.568， P<0.01）. Also， the time effect， group effect as well as interaction effect of time and group of MoCA total score in both groups were statistically significant （F=79.186， 6.026， 20.417， P<0.05 or 0.01）. The time effect， group effect as well as the interaction effect of time and group for FT3 level and FT4 level were statistically significant in both groups （F=75.973， 20.287， 0.961， 84.194， 0.142， 8.299， P<0.05 or 0.01）. According to the simple effect analysis. After the treatment， the MoCA total score in both groups was higher than that before treatment， while FT3 and FT4 levels were lower than those before treatment （F=15.864， 5.421， 8.524， 6.443， 7.628， 3.639， P<0.01）. After the 6-week treatment， the MoCA total score as well as FT3 and FT4 level differences in escitalopram and paroxetine groups were of statistical significance （t=5.841， -0.705， -2.349， P<0.05 or 0.01）. The MoCA score difference before and after treatment in paroxetine group was positively correlated with FT3 and FT4 levels after treatment （r=0.276， 0.382， P<0.05 or 0.01）. ConclusionBoth escitalopram and paroxetine can improve cognitive function in patients with first-episode depressive disorder. The improvement may be related to the changes in serum FT3 and FT4 levels.

Objective: To investigate the efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) assisted with submental mini-incision in early thyroid papillary carcinoma. Methods: A total of 63 patients with early papillary thyroid carcinoma (cT1N0M0) were included who underwent TOETVA from December 2019 to May 2021 in Department of Thyroid Surgery of the Affiliated Hospital of Jining Medical University. There were 4 males and 59 females, aged from 17 to 46 years old. Of those 36 patients received traditional TOETVA as control and 27 patients accepted modified TOETVA assisted with submental mini-incision. The clinical outcomes of patients in two groups were compared. Chi-square test and t test were used in statistical analyses. Results: Compared to control group, modified TOETVA group had the less mean operation time [(146.63±38.62) minutes vs. (167.78±36.71) minutes, t=-2.21, P=0.031], the shorter time required for returning to normal diet after operation [(2.11±0.89) days vs. (2.72±1.16) days, t=-2.28, P=0.026], and the lower probability of mandibular numbness (0 vs. 16.67%, χ²=4.97, P=0.026). There was no significant difference between two groups in intraoperative blood loss, postoperative drainage volume, number of central lymph nodes dissection, and postoperative complications such as gas embolism, postoperative bleeding, postoperative infection, skin burns, subcutaneous effusion and so on(all P>0.05). After 6 months of operation, the thyroid ultrasound of the patients in two groups showed no recurrence, and the patients were satisfied with their surgical incision appearances. Conclusion: Both the modified and traditional TOETVA show similar efficacies for treatments of early thyroid papillary carcinoma, but the modified TOETVA can reduce the operation time and improve the quality of life.
Adolescent ; Adult ; Carcinoma, Papillary/surgery* ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology* ; Quality of Life ; Surgical Wound/surgery* ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/pathology* ; Thyroidectomy/adverse effects* ; Young Adult

Objective: To investigate the expression characteristics of Tim-3 on natural killer (NK) cells of peripheral blood in patients with acute myeloid leukemia (AML) and its clinical significance. Methods: Peripheral blood was obtained from 39 patients with newly diagnosed AML before intervention, with peripheral blood from 28 cases of healthy volunteers collected as normal control. Using CD3, CD56 and Tim-3 as markers, expression levels of Tim-3 on the peripheral blood NK cells were detected by immune fluorescence labeling and flow cytometry. Results: The ratio of the peripheral blood CD3^-CD56⁺ NK cells in newly diagnosed AML patients (5.74±5.31) %decreased significantly, compared with the normal control (12.55±6.33) % (t=4.596, P<0.001) . Tim-3 expression on the peripheral blood NK cells in newly diagnosed AML patients (42.67±19.08) % decreased significantly, compared with the normal control group (60.99±20.69) % (t=3.781, P<0.001) . CD3^-CD56⁺NK cell ratio of peripheral blood in AML patients was significantly correlated with Chromosome karyotype (t=2.915, P<0.005) . Expression level of Tim-3 on NK cells in the peripheral blood of AML patients had significant correlation with ratio of CR and NCCN high risk group (P<0.05) . Conclusion The rate of NK cells in peripheral blood and the expression level of Tim-3 on NK cells in AML patients decreased significantly.The lower expression level of Tim-3 on NK cells correlate with prognosis of AML.

Objective: To investigate the expression characteristics of Tim-3 on natural killer (NK) cells of peripheral blood in patients with acute myeloid leukemia (AML) and its clinical significance. Methods: Peripheral blood was obtained from 39 patients with newly diagnosed AML before intervention, with peripheral blood from 28 cases of healthy volunteers collected as normal control. Using CD3, CD56 and Tim-3 as markers, expression levels of Tim-3 on the peripheral blood NK cells were detected by immune fluorescence labeling and flow cytometry. Results: The ratio of the peripheral blood CD3(-)CD56(+) NK cells in newly diagnosed AML patients (5.74±5.31) %decreased significantly, compared with the normal control (12.55±6.33) % (t=4.596, P<0.001) . Tim-3 expression on the peripheral blood NK cells in newly diagnosed AML patients (42.67±19.08) % decreased significantly, compared with the normal control group (60.99±20.69) % (t=3.781, P<0.001) . CD3(-)CD56(+)NK cell ratio of peripheral blood in AML patients was significantly correlated with Chromosome karyotype (t=2.915, P<0.005) . Expression level of Tim-3 on NK cells in the peripheral blood of AML patients had significant correlation with ratio of CR and NCCN high risk group (P<0.05) . Conclusion: The rate of NK cells in peripheral blood and the expression level of Tim-3 on NK cells in AML patients decreased significantly.The lower expression level of Tim-3 on NK cells correlate with prognosis of AML.
Flow Cytometry ; Hepatitis A Virus Cellular Receptor 2/metabolism* ; Humans ; Killer Cells, Natural ; Leukemia, Myeloid, Acute ; Prognosis

Objective: To investigate the value of karyotype analysis, bacterial artificial chromosomes-on-beads (BoBs), chromosome microarray analysis (CMA) and fluorescence in situ hybridization (FISH) in the diagnosis of sex chromosome numerical and structural abnormalities. Methods: Conventional G-banding staining technique was used to analyze the karyotypes of amniotic fluid cells and parental peripheral blood cells in two pregnancies with prenatal diagnosis indications. Sex chromosome numerical and structural abnormalities were analyzed based on the results of G-banding, BoBs, CMA and FISH. Results: The results of G-banding karyotype analysis showed that there were mosaics in amniotic fluid cells collected from both cases. Karyotype of Case A was 45,X[25]/46,X,idic(Y)(q11.2?)[6], and Case B was 45,X[39]/46,X,psu idic(X)(q21.32?)[44]. Parental peripheral blood karyotypes of both families were normal. Prenatal BoBs indicated copy number abnormalities in sex chromosomes (Y chromosome in Case A and X chromosome in Case B). CMA results suggested a 20.1 Mb duplication in Yp11.32q11.222, and a 7.7 Mb deletion in Yq11.222q11.23 in fetus A with possible karyotype of 46,X,idic(Y)(q11.222); for fetus B, a 92.0 Mb duplication in Xp22.33q21.32, and a 63.0 Mb deletion in Xq21.32q28 were detected, and the karyotype might be 46,X,psu idic(X)(q21.32). The mid-term FISH test of amniotic fluid cells showed that 90% of the amniotic cells from Case A were 45,X, and 10% were 46,X,idic(Y)(q11.2); about 38% were 45,X, and 62% were 46,X,psu dic(X)(q21.3) from Case B. Conclusions Numerical and structural abnormalities of sex chromosomes could be accurately diagnosed by combination of several methods including G-banding karyotype analysis, prenatal BoBs, CMA and FISH, which would help to effectively reduce birth defects.

OBJECTIVE：To establish the metho d for the content determination of 8 nucleosides in wild and cultivated Pinellia ternate，and to conduct the difference analysis. METHODS ：The contents of uracil ，uridine，inosine，xanthine，adenine， guanosine，β-thymidine and adenosine in 20 batches of P. ternate （wild product YS 1-YS8，cultivated product ZP 1-ZP12）were determined by HPLC method. Based on the contents of the above 8 nucleosides，cluster analysis ，principal component analysis （PCA），partial least squares analysis （OPLS-DA）were used to comprehensively evaluate the wild and cultivated P. ternata . RESULTS：The contents of uracil ，uridine，inosine，xanthine，adenine，guanosine，β-thymidine and adenosine in 20 batches of P. ternate were 0.02-0.24，0.01-0.24，0.06-0.37，0.02-0.14，0.04-0.22，0.14-0.42，0.01-0.09，0-0.32 mg/g，respectively. Cluster analysis，PCA and OPLS-DA showed that 8 batches of wild P. ternate （YS1-YS8）were clustered into one category ，and 12 batches of cultivated P. ternate （ZP1-ZP12）were clustered into one category. Main characteristic markers of wild P. ternate were guanosine，uridine，adenosine and adenine ，while the main characteristic markers of cultivated P. ternate were urinine ，xanthine， inosine，and β-thymidine. CONCLUSIONS：The method for the content determination of 8 nucleosides in P. ternate is established. Nucleosides as quality markers can effectively distinguish wild and cultivated P. ternata ，and the quality of the wild P. ternate was better than that of cultivated P. ternate .