Objective To explore the curative effect of insulin combined with An Er Shu in treatment ofⅡtoⅢ degree pressure sores of elderly patients with diabetes mellitus. Methods A total of 120 cases of elderly diabetes mellitus patients with Ⅱ to Ⅲ degree pressure sores were randomly divided into the control group (30 cases, conventional nursing treatment), the experimental group 1 (30 cases, insulin spray coating), the experimental group 2 (30 cases, An Er Shu brushing besmear), and the experimental group 3(30 cases, insulin combined An Er Shu). The curative effect and the healing time were observed. Results After four weeks treatment total effective rate was 60.0%(18/30) in the control group, 66.7%(20/30) in the experimental group 1, 76.7%(23/30) in the experimental group 2, 100.0%(30/30) in the experimental group 3, and there was significant difference in the 3 experimental groups comparing with the control group, the experimental group 1 and the experimental group 2, respectively (χ2=15.000, 12.000, 5.822, P<0.05 or 0.01). The healing time ofⅡdegree pressure sores was (19.03 ± 0.85) d in the control group, (18.90 ± 0.92) d in the experimental group 1, (18.43 ± 0.82) d in the experimental group 2, and (16.97 ± 1.25) d in the experimental group 3, and there was significant difference in the experimental group 3 comparing with the control group, experimental group 1 and experimental group 2, respectively (t=8.013, 7.918, 8.930, P<0.01), and in the experimental group 2 comparing with the control group (t=3.525, P<0.01). The healing time ofⅢdegree pressure sores was (24.17 ± 1.51) d in the control group, (23.63 ± 1.33) d in the experimental group 1, (23.47 ± 1.25) d in the experimental group 2, and (21.07 ± 1.46) d in the experimental group 3, and there was significant difference in the experimental group 3 comparing with the control group, experimental group 1 and experimental group 2, respectively (t=6.918, 7.048, 9.200, P<0.01). Pressure sores area reduction was (44.47 ± 37.63)%in the control group, (56.50 ± 39.64)%in the experimental group 1, (66.23 ± 37.54)%in the experimental group 2, and (96.52 ± 7.71) % in the experimental group 3, and there was significant difference in the experimental group 3 comparing with the control group, the experimental group 1 and the experimental group 2, respectively (Z=-4.274,-4.274,-3.400, P<0.01). Conclusions Insulin combined An Er Shu in treatment of pressure sores in elderly patients with diabetes mellitus can improve curative effect and shorten the healing time.

Justified the necessity of remote pathology consultation in China, and described the basic approach of such consultation in terms of the conditions, organizational framework, specialists and consultation process of the hospital. on the basis of benefit in pationts, the consultation helps the development of the pathology department and other specialist departments at the same time, builds initially a pathology quality control system, and accelerates the multi-discipline diagnosis and treatment approach. Expect to encourage contemplation on international remote pathology consultation in an effort to improve such a practice for the benefit of patients.

Objective To analyze the background and connotation of the maker education 2.0 and the innovativeness of the nursing maker education 2.0, and put forward the blended teaching of the nursing maker education 2.0. Methods The present situations of the maker education 2.0 and the connections between the maker education 2.0 and the nursing education were analyzed through documents and descriptive research, and the blended teaching program of the nursing maker education 2.0 was designed through exploratory research. Results Maker education 2.0 has gradually became an important way to cultivate students' innovation ability, and all kinds of schools tried to implement the maker education 2.0, but there has not been relevant research reports in nursing. Conclusions The blended teaching of the nursing maker education 2.0 can triggerthe reform of the nursing education. We should research the developmental mechanism and supporting theory, etc. of the nursing maker education 2.0 to explore much further for more knowledge about its application results.

Rhythm of blood pressure refers to the circadian variation of blood pressure, which is regulated by clock genes. However, the rhythm disorder of blood pressure increases the risk of stroke. Taking the process of blood pressure regulation as a clue and focusing on the clock gene pathway, this article explores the possible mechanism of period gene regulating renin-angiotensin-aldosterone system in rhythm of blood pressure, so as to provide reference for the in-depth study of the relevant mechanism of rhythm disorder of blood pressure and search for a new target for the primary prevention of cerebrovascular diseases.

Objective:To investigate the changes of blood pressure and serum circadian clock protein levels after cerebral ischemia-reperfusion in spontaneously hypertensive rat (SHR) and their correlation.Methods:The middle cerebral artery occlusion method was used to prepare the SHR cerebral ischemia-reperfusion model at zero point of Zeitgeber Time (ZT), and the systolic blood pressure within 24 h was continuously monitored after the model was made. The tail vein blood of rats was taken every 3 h, and the changes in serum circadian clock proteins (CLOCK, BMAL1, PER1 and CRY1) levels were detected by enzyme-linked immunosorbent assay. Pearson correlation analysis was used to determine the relationship between blood pressure circadian rhythm pattern and circadian clock protein level fluctuation after cerebral ischemia-reperfusion.Results:In the sham operation group, there were various blood pressure patterns, including dipper (53%), non-dipper (27%), super dipper (13%), and reverse dipper (7%), and the main pattern was dipper. In contrast, the degree of blood pressure disorder in the model group was aggravated, and the non-dipper was the main type, with the proportion as high as 40%. The proportion of super dipper and reverse dipper increased to 27% and 13% respectively; proportion of dipper blood pressure decreased to 20%. The serum level of CLOCK in the model group was relatively stable, while the circadian rhythm of BMAL1, PER1 and CRY1 was significantly changed compared with the sham operation group. Pearson analysis showed that PER1 was negatively correlated with the dipper ( r=-0.565, P=0.002) and super dipper ( r=-0.531, P=0.001) blood pressure patterns, and positively correlated with the non-dipper blood pressure pattern ( r=0.620, P<0.001). Conclusion:The circadian rhythm pattern of blood pressure in SHR after cerebral ischemia-reperfusion was obviously disordered, which was closely associated with the regulation of Per1 gene.

Personalized management of ischemic stroke prevention and treatment remains a top priority in the field of neurology. The purpose of this article is to elucidate the role of nontraditional lipid profile and traditional lipids in the pathogenesis and recurrence of acute ischemic stroke in order to provide new indicators for stroke prevention, risk grading and high-risk population screening, and attempt to discuss the potential predictive value of nontraditional lipid indicators.

Almost all life on Earth has a 24 h circadian rhythm. The circadian clock that controls the circadian rhythm is an important regulator of physiology and disease. Disturbance of circadian rhythm can negatively affect physiological homeostasis at the molecular, cellular, organ system, and whole organism levels. The circadian clock rhythm disorders are considered to be involved inmany cardiocerebrovascular diseases, such as ischemic stroke and myocardial infarction. Ischemic stroke is one of the main causes of long-term disability and death worldwide. The incidence is higher in the daytime and lower at night, but the exact mechanism of this time distribution is unclear. This article discusses the role of the circadian clock in stroke pathophysiological mechanism and the specific molecular mechanism of clock gene regulation. It is expected that molecular time can be used or changed to open up new targets for stroke treatment.

Objective　To systematically evaluate the effect of systolic and diastolic blood pressure on the progression of White matter lesions. Methods　The title term “white matter” “Leukoencephalopathy” “leukoaraiosis” “blood pressure” “hypertension” in PubMed and Cochrane Library were searched for 174 AND 101 articles respectively from 1981 to August 2019.Then two researchers independently screened AND evaluated the included literatures，AND meta-analysis was performed using RevMan 5.3 software. Results　Finally，a total of 11 closely related studys were included for research. The results of meta-analysis showed that the increase of systolic blood pressure and diastolic blood pressure could promote the progression of white matter lesions（Respectively OR=2.90，95%CI 2.86～2.95；OR=3.13，95%CI 3.03～3.23），especially in diastolic blood pressure. Conclusion　The increase of systolic blood pressure and diastolic blood pressure can promote the progress of white matter lesions，but it is more closely related to diastolic blood pressure. Therefore，more researchers are expected to pay attention to the change of diastolic blood pressure，and more importantly，to identify the range of blood pressure and control strategies that control diastolic blood pressure is beneficial to delay the progress of white matter lesions，especially for patients under 70 years old.

ObjectiveTo investigate the different effects of Yunvjian with or without Achyranthis Bidentatae Radix on glucose and lipid metabolism and inflammatory response in diabetic rats with the syndrome of Yin deficiency and internal heat. MethodThe rat model of diabetes due to Yin deficiency and internal heat was established by feeding with a high-sugar and high-fat diet and injection of thyroxine and streptozotocin. The successfully modeled rats were randomized into model control， Yunvjian without Achyranthis Bidentatae Radix （11.8 g·kg^-1）， Yunvjian with Achyranthis Bidentatae Radix （12.8 g·kg^-1）， and Achyranthis Bidentatae Radix （1.0 g·kg^-1） groups （n=10）， and another 10 rats were taken as the normal control group. Each group was administrated with corresponding drugs or saline by gavage for 28 days. The fasting blood glucose （FBG）， fasting insulin （FINS）， total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） in rats were measured. Enzyme-linked immunosorbent assay was employed to determine the levels of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， triiodothyronine （T₃）， thyroxine （T₄）， interleukin （IL）-1β， IL-6， tumor necrosis factor （TNF）-α， and C-reactive protein （CRP） in the serum. The histopathological changes of the liver were observed. The expression of lipoxygenase-2 （COX-2） was detected by immunofluorescence. The mRNA levels of nuclear transcription factors-κB （NF-κB）， monocyte chemotactic protein-1 （MCP-1）， and intercellular adhesion molecule-1 （ICAM-1） were determined by real-time polymerase chain reaction （Real-time PCR）.Western blot was employed to determine the protein levels of NF-κB in hibitory protein（IκB） kinase β （IKKβ）， IκBα， and phosphorylated IκBα （p-IκBα） in the liver and the protein levels of NF-κB in the cytoplasm and nucleus. ResultCompared with the normal group， the model group showed elevated levels of FBG， FINS， insulin resistance index， TC， TG， LDL-C， cAMP， T₃， T₄， IL-1β， IL-6， TNF-α， and CRP， up-regulated mRNA levels of NF-κB， MCP-1， and ICAM-1， and up-regulated protein levels of COX-2， p-IκBα， and nuclear NF-κB （P<0.01）. Compared with the model group， Yunvjian without Achyranthis Bidentatae Radix lowered the levels of FBG， FINS， insulin resistance index， TC， TG， LDL-C， cAMP， T₃， T₄， IL-1β， IL-6， TNF-α， and CRP， down-regulated the mRNA levels of NF-κB， MCP-1， and ICAM-1， and down-regulated the protein levels of COX-2， p-IκBα and nuclear NF-κB （P<0.05， P<0.01）. Compared with the Yunvjian without Achyranthis Bidentatae Radix， Yunvjian with Achyranthis Bidentatae Radix showed lowered levels of FBG， FINS， insulin resistance index， and inflammatory cytokines， down-regulated mRNA levels of NF-κB， MCP-1， and ICAM-1， and down-regulated protein levels of p-IκBα and nuclear NF-κB （P<0.05， P<0.01）. ConclusionAchyranthis Bidentatae Radix can enhance the performance of Yunvjian in reducing blood glucose and inhibiting inflammation in diabetic rats with the syndrome of yin deficiency and internal heat by down-regulating the IKK/IκB/NF-κB signaling pathway.