Objective Based on the endoplasmic reticulum stress(ERS)inositol-requiring enzyme-1α(IRE1α)/apoptosis signal-regulated kinase 1(ASK1)/c-Jun N-terminal kinase(JNK)pathway to investigate the intervention effect of Ziziphi Spinosae Semen(ZSS)-Albiziae Flos(AF)on the depression model of rats,which were prepared by solitary rearing combined with chronic unpredictable mild stress(CUMS).Methods A total of 144 rats were randomly divided into normal group,model group,high-,medium-and low-dose groups of ZSS-AF,and Venlafaxine group.In addition to the normal group,the rats in other groups were isolated for 21 days combined with CUMS to prepare the depression model.The behavioral changes of rats were observed by open field test and Morris water maze test.The ultrastructural changes of hippocampal neurons were observed by transmission electron microscope.TUNEL staining was used to observe the apoptosis of nerve cells in hippocampus.The protein expression levels of IRE1α,phosphorylated(P)-IRE1α,ASK1,P-ASK1,JNK,P-JNK,B cell lymphoma-2(Bcl-2),Bcl-2 associated X protein(Bax)and cysteme aspartate specific protease-3(Caspase-3)in hippocampus were detected by Western Blot.The mRNA expression levels of IRE1α,ASK1,JNK,Bax,Bcl-2 and Caspase-3 in hippocampus were detected by Real-Time PCR.Results Compared with the normal group,the scores of horizontal movement and vertical movement in the open field test of rats in the model group were decreased(P＜0.01).In the water maze test,the escape latency was increased and the number of crossing the original platform was decreased(P＜0.01).The number of hippocampal apoptosis was increased(P＜0.01).The protein expression levels of P-IRE1 α/IRE1 α,P-ASK1/ASK1,P-JNK/JNK,Bax,Caspase-3 and mRNA expressions of IRE1α,ASK1,JNK,Bax,Caspase-3 in hippocampus were increased,while the protein and mRNA expression levels of Bcl-2 were decreased(P＜0.01).Compared with model group,the scores of horizontal movement and vertical movement in the open field test of rats in each dose ZSS-AF groups and Venlafaxine group were increased(P＜0.01).In the water maze test,the escape latency was decreased and the times of crossing the original platform was increased(P＜0.01).The number of hippocampal apoptosis was decreased(P＜0.01).The mRNA expression levels of P-IRE1α/IRE1α,P-ASK1/ASK1,P-JNK/JNK,Bax,Caspase-3 protein and IRE1α,ASK1,JNK,Bax,Caspase-3 in hippocampus were decreased,while the protein and mRNA expression levels of Bcl-2 were increased(P＜0.05,P＜0.01).The effect of medium-dose ZSS-AF group was better than that of high-and low-dose groups.Conclusion ZSS-AF may play an antidepressant role by regulating IRE1α/ASK1/JNK pathway of endoplasmic reticulum stress.

Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective To test the reliability and validity of the Chinese version of the Caregiver Contri-bution to Self-Care of Chronic Illness Inventory in the caregivers of elderly patients with COPD.Methods The general information questionnaire and the Chinese version of the Caregiver Contribution to Self-Care of Chronic Illness Inventory were used to conduct questionnaire survey on 220 caregivers of elderly patients with COPD treated or hospitalized in the respiratory medicine department of a tertiary hospital in Hebei Province from October 2022 to February 2023,and the reliability and validity of the scale were tested.Results The i-tem-level content validity index was 0.833-1.000,the content validity index at the level of unanimity scale was 0.842 and the content validity index of the average scale level was 0.973.The confirmatory factor analysis showed that all the fitting indicators of the total scale and the caregiver's contribution to self-care mainte-nance,monitoring contribution and management contribution subscale were within the acceptable range.The Cronbach's α coefficients of the total scale and the three subscales were 0.918,0.865,0.830 and 0.897,re-spectively.The split-half reliabilities of the total scale and the three subscales were 0.843,0.855,0.842 and 0.906,respectively.The test-retest reliabilities of the total scale and the three subscales were 0.849,0.734,0.751 and 0.773,respectively.Conclusion The Chinese version of the Caregiver Contribution to Self-Care of Chro-nic Illness Inventory has good reliability and validity,and can be used as a reliable tool to measure the caregivers con-tribution to elderly COPD patients self-care.

Objective:To investigate the association of malnutrition based on Global Leadership Initiative on Malnutrition (GLIM) criteria with the disease activity and clinical outcomes in hospitalized ulcerative colitis (UC) patients.Methods:Clinical data of 115 patients with UC hospitalized in the Affiliated Hospital of Qingdao University from September 2019 to March 2023 were prospectively analyzed. GLIM and European Society for Clinical Nutrition and Metabolism (ESPEN) 2015 criteria were used for the diagnosis of malnutrition, allowing the analysis of consistency between two diagnostic criteria for malnutrition. The relationship between malnutrition based on GLIM criteria and disease activity and clinical outcome was further investigated. The risk factors of adverse clinical outcomes in UC patients were analyzed using binary logistic regression.Results:GLIM and ESPEN 2015 diagnostic criteria showed high correlation and consistency (AUC=0.875, P<0.001; K=0.809, P<0.001). According to GLIM criteria, the prevalence of malnutrition among hospitalized UC patients was 32.17% (37 cases). Compared with non-malnourished UC patients, the modified Mayo score and C-reactive protein level of malnutrition patients were higher ( P<0.005), and the proportion of patients with severe disease activity was higher ( P=0.005). UC patients in the malnourished group had longer hospital stay ( P<0.001), higher hospitalization costs ( P<0.001), and higher rates of drug escalation/conversion therapy, re-admission and surgery at 12 weeks and 54 weeks ( P<0.05). Binary logistic regression analysis showed that a high Mayo score ( OR=3.606, P=0.016), a high modified Mayo score ( OR=1.346, P=0.009) and malnutrition ( OR=1.430, P=0.012) were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 12 weeks. A high modified Mayo score ( OR=6.491, P=0.011) and malnutrition as per GLIM criteria ( OR=6.693, P=0.033) were independent risk factors for adverse clinical outcomes of hospitalized UC patients at 54 weeks. Conclusions:GLIM and ESPEN 2015 diagnostic criteria show high consistency in the diagnosis of malnutrition in hospitalized UC inpatients. Malnutrition may imply adverse clinical outcomes of hospitalized UC patients, which is an independent risk factor for the adverse clinical outcome of hospitalized UC patients.

Background: and Purpose CGG repeat expansion in the 5' untranslated region (5'UTR) of the Notch 2 N-terminal-like C gene (NOTCH2NLC) has been associated with neuronal intranuclear inclusion disease (NIID) and oculopharyngodistal myopathy type 3 (OPDM3). Few OPDM3 patients have been reported. This report describes two OPDM3 patients with novel imaging findings who presented the typical features of NIID, and reviews all OPDM3 cases available in the literature. Methods: The available clinical, imaging, and pathological information was reviewed and investigated. CGG repeat expansion in the 5'UTR of NOTCH2NLC was tested using the repeatprimed polymerase chain reaction (PCR), followed by the fluorescence amplicon-length PCR to determine the number of CGG repeats. Results: Our two OPDM3 patients and most patients reported in the literature developed the typical clinical characteristics of NIID, including leukoencephalopathy, peripheral neuropathy, cognitive deterioration, pigmentary retinopathy, ataxia, tremor, acute encephalitis-like episodes, pigmentary retinopathy, miosis, and sensorineural hearing loss. In addition to typical imaging findings of NIID, our two patients exhibited diffusion weighted imaging (DWI) hyperintensities in the middle cerebellar peduncles, which have not been described previously. Muscle biopsies revealed rimmed vacuoles and p62-positive intranuclear inclusions in the myofibers in both patients. The skin biopsy performed in one patient detected typical eosinophilic intranuclear inclusions. Genetic analysis identified CGG repeat expansion in NOTCH2NLC as the causative mutation in the two patients. Conclusions Our two patients with OPDM3 had clinical characteristics of NIID and exhibited DWI abnormality in the cerebellum. Our results indicate that OPDM3 is within the spectrum of NIID and that DWI hyperintensities in the cerebellum are helpful for diagnosing NIID or OPDM3.

Background: and Purpose CGG repeat expansion in the 5' untranslated region (5'UTR) of the Notch 2 N-terminal-like C gene (NOTCH2NLC) has been associated with neuronal intranuclear inclusion disease (NIID) and oculopharyngodistal myopathy type 3 (OPDM3). Few OPDM3 patients have been reported. This report describes two OPDM3 patients with novel imaging findings who presented the typical features of NIID, and reviews all OPDM3 cases available in the literature. Methods: The available clinical, imaging, and pathological information was reviewed and investigated. CGG repeat expansion in the 5'UTR of NOTCH2NLC was tested using the repeatprimed polymerase chain reaction (PCR), followed by the fluorescence amplicon-length PCR to determine the number of CGG repeats. Results: Our two OPDM3 patients and most patients reported in the literature developed the typical clinical characteristics of NIID, including leukoencephalopathy, peripheral neuropathy, cognitive deterioration, pigmentary retinopathy, ataxia, tremor, acute encephalitis-like episodes, pigmentary retinopathy, miosis, and sensorineural hearing loss. In addition to typical imaging findings of NIID, our two patients exhibited diffusion weighted imaging (DWI) hyperintensities in the middle cerebellar peduncles, which have not been described previously. Muscle biopsies revealed rimmed vacuoles and p62-positive intranuclear inclusions in the myofibers in both patients. The skin biopsy performed in one patient detected typical eosinophilic intranuclear inclusions. Genetic analysis identified CGG repeat expansion in NOTCH2NLC as the causative mutation in the two patients. Conclusions Our two patients with OPDM3 had clinical characteristics of NIID and exhibited DWI abnormality in the cerebellum. Our results indicate that OPDM3 is within the spectrum of NIID and that DWI hyperintensities in the cerebellum are helpful for diagnosing NIID or OPDM3.

Background: and Purpose CGG repeat expansion in the 5' untranslated region (5'UTR) of the Notch 2 N-terminal-like C gene (NOTCH2NLC) has been associated with neuronal intranuclear inclusion disease (NIID) and oculopharyngodistal myopathy type 3 (OPDM3). Few OPDM3 patients have been reported. This report describes two OPDM3 patients with novel imaging findings who presented the typical features of NIID, and reviews all OPDM3 cases available in the literature. Methods: The available clinical, imaging, and pathological information was reviewed and investigated. CGG repeat expansion in the 5'UTR of NOTCH2NLC was tested using the repeatprimed polymerase chain reaction (PCR), followed by the fluorescence amplicon-length PCR to determine the number of CGG repeats. Results: Our two OPDM3 patients and most patients reported in the literature developed the typical clinical characteristics of NIID, including leukoencephalopathy, peripheral neuropathy, cognitive deterioration, pigmentary retinopathy, ataxia, tremor, acute encephalitis-like episodes, pigmentary retinopathy, miosis, and sensorineural hearing loss. In addition to typical imaging findings of NIID, our two patients exhibited diffusion weighted imaging (DWI) hyperintensities in the middle cerebellar peduncles, which have not been described previously. Muscle biopsies revealed rimmed vacuoles and p62-positive intranuclear inclusions in the myofibers in both patients. The skin biopsy performed in one patient detected typical eosinophilic intranuclear inclusions. Genetic analysis identified CGG repeat expansion in NOTCH2NLC as the causative mutation in the two patients. Conclusions Our two patients with OPDM3 had clinical characteristics of NIID and exhibited DWI abnormality in the cerebellum. Our results indicate that OPDM3 is within the spectrum of NIID and that DWI hyperintensities in the cerebellum are helpful for diagnosing NIID or OPDM3.

Objective:To investigate the risk factors associated with post-thrombotic syndrome (PTS) within 2 years after the first diagnosis of deep venous thrombosis (DVT) of the lower extremities.Methods:The clinical data and 2-year follow-up data of 260 patients who were first diagnosed with DVT at our department from Jan 2017 to May 2019 were retrospectively analyzed.By Villalta score, the patients were divided into non-PTS group, mild PTS group and moderate-severe PTS group. Ordered multiple classification logistic regression was used to analyze the risk factors for the development of PTS.Results:The incidence of mild and moderate-severe PTS was 22.7% and 15.8%, respectively. Multivariate Logistic regression analysis showed that recurrence history of DVT ( OR=4.754, 95% CI 1.84-12.01, P=0.001), duration of oral anticoagulation treatment ≤6 months (0-3 months: OR=7.791, 95% CI 1.79-33.90, P=0.006; 4-6 months: OR=4.242, 95% CI 1.13-15.99, P=0.033), time length of stretch sock wearing≤ 12 months (0-6 months: OR=9.708, 95% CI 1.81-52.14, P=0.008; 7-12 months: OR=4.899, 95% CI 1.42-16.88, P=0.012) and exercise frequency ≤4 times/week (1-2 times/week: OR=7.691, 95% CI 1.92-30.72, P=0.004; 3-4 times/week: OR=4.284, 95% CI 1.33-13.80, P=0.015) were risk factors for PTS. Catheterized thrombolytic therapy ( OR=0.436, 95% CI 0.20-0.96, P=0.039) and low body mass index (BMI<18.5 kg/m 2: OR=0.142, 95% CI 0.02-0.81, P=0.028), central thrombus ( OR=0.322, 95% CI 0.15-0.72, P=0.005) and peripheral thrombus ( OR=0.020, 95% CI 0.01-0.07, P<0.001) were protective factors for PTS. Conclusions:Patients with DVT have a high risk of developing PTS within 2 years. Catheter-directed thrombolysis, no history of recurrence of DVT, low BMI (<18.5 kg/m 2), central or peripheral thrombosis, long-term oral anticoagulant therapy (≥7 months), longer wearing time of elastic socks (≥1 year), and higher exercise frequency (≥ 5-6 times/week) can be conducive to the reduction of incidence and severity of PTS.

Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disease, characterized by eosinophilic transparent inclusions in the central and peripheral nervous systems, and internal organs. NIID clinical characteristics are varied, including cognitive impairment, muscle weakness, episodic symptoms, movement disorders and autonomic dysfunction. This article reports a patient with NIID who manifested with episodes of aphasia, dysgraphia and dyslexia without fever, headache, nausea and vomiting confirmed by genetic testing. The patient was a 62-year-old female with acute onset who was diagnosed with transient ischemic attack. This article aims to improve the knowledge of NIID with stroke-like onset by this case presentation and avoid misdiagnosis.

Objective:To evaluate percutaneous mechanical thrombectomy (PMT) using Aspirex device for treating acute iliofemoral deep vein thrombosis (IFDVT).Methods:The clinical and follow-up data of 68 patients with IFDVT at our institution from Jan 2019 to Jun 2021 was retrospectively analyzed.Results:Twenty-six patients who had received PMT combined with auxiliary catheter directed thrombolysis (CDT) were included into group A, and 42 patients received CDT alone were into group B.The final thrombus clearance rates were more than 50%, and the clinical efficacy of thrombolysis was achieved. Group A associated a significant reduction in lysis duration and UK dosage and hospital days and degree of detumescence after 24 h compared with group B,and all aforementioned differences were statistically significant. Hospitalization costs in group A were more than group B. At one year follow-up, there were no significant differences between the two groups in the cumulative prevalence post-thrombotic syndrome (PTS) and the Villalta score and primary patency (92.0% vs. 90.0% , χ2=0.059, P=0.807). Conclusions:The application of PMT using the Aspirex device for acute IFDVT was safe and effective, which could accelerate the clearance of thrombus, and reduce UK dosage, lysis duration, hospital days. However, it increased the hospitalization costs.