Objective:To describe antipsychotic medication prescription patterns and estimate the associated costs for patients with schizophrenia in Tianjin,China. Methods:Data were 30%random sampling from the Tianjin Urban Employee Basic Medical Insurance (UEBMI)database. Adult patients with≥ 1 diagnosis of schizophrenia, antipsychotics prescribed at the first diagnosis of schizophrenia (index date),and 12-month continuous enrollment after the first antipsychotic prescription (follow-up period)between 2008 and 2010 were included. The classes and number of antipsychotics patients prescribed at index date and patterns of antipsychotics patients maintained/changed during the study period were described. The total direct medical costs were also estimated. Results:Among 2125 patients with schizophrenia,1739 (81. 8%)prescribed with antipsychotic medication prescriptions were in-cluded. At the index date,1461 (84. 0%)of the patients prescribed with one antipsychotic medication,278 (16. 0%)with more than two antipsychotics,and 747 (43. 0%)were prescribed with first-generation antipsychot-ics,813 (46. 8%)with second-generation antipsychotics and 179 (10. 2%)with both. During the following 12 months,1387 (79. 8%)patients remained on the index antipsychotic class. The total cost for 1739 patients was (12498. 9 ±14575. 2)CNY. The total direct medical cost was significantly lower for patients only prescribed with second-generation antipsychotics compared with ones only with first-generation antipsychotics [(9064. 1 ±13209. 8) CNY vs. (1 1928. 6 ±13767. 4)CNY,P<0. 001 ]. In addition,the cost for patients prescribed with first-generation and second-generation antipsychotics was 18821. 8 ±15702. 7 CNY. Conclusion:Majority of patients are prescribed with monotherapy,and tend to stay with one antipsychotic medication class. The total medical cost for patients with second-generation antipsychotic medications is lower than first-generation ones.

Objectives:To explore the effects of love resources and the lovers'resources equivalence on their romantic relationship quality.Methods:A sample of 203 pairs of lovers from 5 provinces and municipalities were selected(aged from 15 to 29).They were assessed with the Evaluation Form of Love Resources for Individual(EFL-RI)and the Scale of Relationship Perception Index for Unmarried People(RPUS)for the evaluation of the relation-ship between the love resource equivalence and the romantic relationship quality.The EFLRI was used to quantify the 12 individual love resources (the appearance of individual,stature,sexual health,health,personality,mental health,sense of responsibility,capacity,professional/occupation,education background,earning and family back-ground).The results included self-evaluation and peer-evaluation.Results:Self-assessment of responsibility between lovers and D-value of mental health were negatively correlated with the reported RPUS scores of both sides (r =-0.20 --0.33,Ps <0.05).The D-values of earning and family background were positively correlated with the re-ported RPUS scores of both sides (r =0.14 -0.25,Ps <0.05).Lovers'peer-evaluation of sexual health scores and the D-values of responsibility were negatively correlated with the reported RPUS scores of both sides (r =-0.25 --0.38,Ps <0.01.The D-values of professional/occupation and family background were positively correlated with the reported RPUS scores of males (r =0.20,0.18,Ps <0.05).Love resources(responsibility,sexual health,educa-tion background of males;appearance,personality,capacity of females )had positive predictability to males'repor-ted RPUS scores (β=0.14 -0.34),love resources(responsibility,appearance,personality,capacity,health of males and health,education background of females )had positive predictability to females'reported RPUS scores (β=0.14 -0.27).Conclusion:It suggests that the equivalence of responsibility resource has a positive influence for the quality of love relationship.The equivalence of family background resource has a negative effect for the quality of love relationship.

Objective To summarize the causes of death and to analyze the risk factors in a surgical intensive care unit (SICU).Methods The relevant information of patients died in the SICU of Xijing Hospital of Fourth Military Medical University in past 15 years (from December 1999 to February 2015) was retrospectively analyzed.The gender,age, reason and date of hospitalization, date of transfer SICU, past medical history, whether or not admitted directly from emergency department, or transferred from other department, operated or not, date of death, the main cause of death, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, the history of undergoing mechanical ventilation, continuous renal replacement therapy (CRRT), or antifungal therapy, as well as the ratio of the patients with body temperature higher than 39 ℃, white blood cell (WBC) count higher than 10 × 109/L, platelet (PLT) count below 100 × 109/L, albumin (Alb) below 35 g/L of two periods, namely from December 1999 to July 2007 (the first period),and from August 2007 to February 2015 (the second period) were compared.The above parameters were compared with those of 201 survivors in SICU, and the risk factors leading to death were analyzed by logistic regression.Results From December 1999 to February 2015, 4 317 patients were taken care of in the SICU.Among them, the number of death was 186, and the mortality rate was 4.3％.In the first time period (from December 1999 to July 2007), the total number of patients was 1 356, and the number of death were 109 (the mortality rate was 8.0％).In the second period, i.e.from August 2007 to February 2015, the number of SICU patients was 2 961, and 77 died (the mortality rate was 2.6％).The difference of mortality rate between the two periods was statistically significant (x2 =66.707, P =0.001).The death rate of patients transferred directly from emergency department in tle first period was 79.8％ (87/109), and it was lower in the second period (51.9％, 40/77, x2 =16.181, P =0.001).The death rate of the patients with blood Alb below 35 g/L in the second period (59.7％, 46/77) was higher than that of the first period (41.3％, 45/109, x2 =6.151, P =0.017).The top three causes of death from December 1999 to February 2015 were sepsis (38.2％), trauma (16.7％), and operation for cancer (14.0％).In the first period, the top three causes of death were sepsis (35.8％), trauma (22.0％),and operation for cancer (13.8％).In the second period, the top three causes of death were sepsis (41.6％), damage of the central nervous system (16.9％), and operation for cancer (14.3％).Top three reasons for SICU admission were trauma (29.03％), abdominal pain (20.97％) and other reasons (18.82％).Top three departments from which the patients were transferred were the emergency department (19.35％), orthopedics department (17.20％), and hepatobiliary department (16.13％).Logistic regression analysis showed that age [odds ratio (OR) =2.025, 95％ confidence interval (95％CI) =1.500-2.734, P =0.000], mechanical ventilation (OR =3.514, 95％CI =1.701-7.259, P =0.001), CRRT (OR =5.604,95％CI =3.003-10.459, P =0.000), body temperature higher than 39 ℃ (OR =1.992, 95％CI =1.052-3.771, P =0.034) were the risk factors of death in SICU patients.Conclusion Sepsis and severe trauma are the leading causes of death in severe SICU patients, to whom with risk factors of death enough attention should be given.

Objective To investigate the effects of α7 nicotinic acetylcholine receptor (α7nAChR) on the inflammatory response induced by lipopolysaccharide (LPS) in RAW264.7 macrophages and its molecular mechanisms. Methods RAW264.7 macrophages were culturedin vitro. Inflammatory cell model was constructed by LPS stimulation. Cells were challenged by LPS (1, 10, 100 and 500μg/L) for 5 hours or 100μg/L LPS for 0, 2, 4, 8, 12, 24, 48 and 72 hours, and the release of tumor necrosis factor-α (TNF-α) was detected by the enzyme linked immunosorbent assay (ELISA). The location of α7nAChR was examined in RAW264.7 macrophages by immunofluorescence. Then the cell proliferation and toxicity kit (CCK-8) was used to detect 1, 10, 100, 1000μmol/L GTS-21, a α7nAchR agonist, on the cell viability after LPS stimulation. ELISA was used to detect 1, 10, 100, 1000μmol/L GTS-21 on the levels of TNF-α, interleukin 1β (IL-1β) after LPS stimulation. Cells were challenged with 100μg/L LPS and 100μmol/L GTS-21, then, the level of high mobility group box 1 (HMGB1) was detected by Western Blot and the intracellular location of HMGB1 and nuclear factor-κB p65 (NF-κB p65) was tested by immunofluorescence.Results LPS increased the level of TNF-α to a peak at the concentration of 100μg/L and at 24 hours after stimulation. Theα7nAChR expressed on the macrophages. The cell viability was decreased in a dose-dependent manner [(96.2±1.0)%, (92.0±1.1)% vs. (86.5±2.2)%, bothP < 0.05]. Compared with the control group, the levels of TNF-α and IL-1βin the supernatant of LPS group were significantly increased [TNF-α (ng/L): 453.0±60.6 vs. 100.8±3.2, IL-1β(μg/L): 8.21±0.31 vs. 0.87±0.16, bothP < 0.05]. TNF-α and IL-1β were significantly decreased by 10μmol/L and 100μmol/L GTS-21 in a dose-dependent manner [TNF-α (ng/L): 227.5±17.5, 81.0±8.8 vs. 453.0±60.6;IL-1β (μg/L): 4.86±0.72, 2.32±0.45 vs. 8.21±0.31, allP < 0.05]. GTS-21 significantly reduced the expression of HMGB1 which was induced by LPS management (gray value: 0.788±0.130 vs. 2.061±0.330,P < 0.05) and reversed LPS-induced HMGB1 cytoplasmic transfer. GTS-21 also reversed LPS-induced nuclear translocation of NF-κB p65. Conclusion GTS-21 reduces the inflammatory response via inhibiting the activation of NF-κB.

Objective To explore the efficacy and adverse reactions of improved VTD regimen (pirarubicin combined with vincristine and dexamethasone) plus low-dose thalidomide in patients of newly diagnosed multiple myeloma(MM).Methods Twenty-nine cases of newly diagnosed MM were enrolled in this study.The improved VTD regimen was intravenous injection vincristine 2 mg/d on the first day,intravenous drip pirarubicin 20-30 mg/d from the first day to the second day,and intravenous drip dexamethasone 8 mg/d from the first day to the tenth day.Twenty-eight days was one course of treatment.Response and adverse reactions were evaluated after 4 course of treatment.On the first day of chemotherapy,all the patients were orally administered thalidomide 50 mg/d.Three days later,thalidomide was added to 100 mg/d and chronically maintained if toxicities could be tolerated.Results There were 3 cases(10.3％) in complete response,12 cases (41.2％) in very good partial response,10 cases (34.5％) in partial response,3 cases (10.3％) in stable disease,and 1 case(3.5％) in progressive disease.The overall response rate was 86.2％.Main adverse reactions were myelosuppression,asthenia and constipation,all could be tolerated.Conclusion It has significant response rate and less side effects of improved VTD regimen plus low-dose thalidomide for the patients of newly diagnosed multiple myeloma,and deserves further clinical practice.

Objective:To investigate the effect of the extract of Schisandra chinensis on the matrix metalloproteinases(MMPs) system in kidney tissue of the diabetic rats,and to explore its protective effect on the kidney tissue from the matrix degradation perspective.Methods:STZ was used to establish rat models of diabetes mellitus.A total of 45 diabetic rats were randomly divided into model group,extract of Schisandra chinensis group and Benazepril group,and there were 15 rats in each group.Another 15 rats were selected and used as normal control group.12 weeks after administration,the routine blood and urine biochemical indexes,the histological changes,blood glucose (BG),blood urea nitrogen(BUN),serum creatinine(Scr),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterin(LDL-C),total cholesterol(T-CHO),and triglyceride(TG) levels,excretion rates of albuminuria and proteinuria of the rats in various groups were detected;the expression amounts of fibronectin (FN),type Ⅳ collagen (Col Ⅳ),and matrix metalloproteinase inhibitor metalloproteinase-2 (TIMP-2) in kidney tissue of the rats were detected by immunohistochemical method;the activity of matrix metalloproteinase-2 (MMP-2) was detected by zymography.Results:Compared with model group,the glomeruli matrix accumulation of the rats in extract of Schisandra chinensis group was significantly improved,the excretion rate of albuminuria,LDL-C level and serum MDA level were decreased(P<0.05),the activities of CAT(P<0.01)and SOD(P<0.05)in kidney tissue were increased,and the level of MDA in kidney tissue was decreased(P<0.05).The immunohistochemistry results showed that compared with model group,the expression amounts of FN,Col Ⅳ,and TIMP-2 in kidney tissue of the rats in extract of Schisandra chinensis group were significantly decreased.The zymography results showed that compared with model group,the activity of MMP-2 in kidney tissue of the rats in extract of Schisandra chinensis group was significantly increased(P<0.05).Conclusion:Extract of Schisandra chinensis has protective effect on the kidney tissue of the diabetic rats induced by STZ,and the mechanism may be related to the inhibition of oxidative stress and the improvement of MMP-2 activity as well as the inhibition of TIMP-2 expression which could improve the matrix degradation.

Objective To investigate the methylation situation of let‐7a‐3 promoter in patients with chronic myeloid leukemia (CML) and its clinical significance .Methods The methylation level of let‐7a‐3 promoter in the bone marrow mononuclear cells of 52 CML patients and 25 controls was detected by using the real‐time quantitative methylation‐specific PCR (RQ‐PCR) .Results The non-hypomethylation of let‐7a‐3 promoter was positive in 31 cases(59 .6% ) of 52 CML patients ,while only 1 case(4% ,1/25) in the control group ,the difference between the two groups were statistically significant (P< 0 .01) .The ROC curve analysis showed that the non -hypomethylation of let‐7a‐3 has better specificity for the auxiliary diagnosis of CML .The significantly posi‐tive correlation was found between the non -methylation level of let‐7a‐3 promoter and the BCR/ABL transcription level (r=0 .641 ,P=0 .001) .In contrast ,there was no obvious correlation between the non -methylation level of let‐7a‐3 promoter and the WBC count ,platelet count and hemoglobin levels(P>0 .05) .The non-hypomethylation level of let‐7a‐3 in chronic phase and accel‐erate phase was significantly higher than that in blastic crisis of CML .Conclusion The hypomethylation level of let‐7a‐3 promoter is decreased with disease progression .

Objective To investigate the value of shear wave elastography (SWE) in the differential diagnosis of biliary atresia (BA) in infants within 60 days.Methods SWE was used to detect the hepatic Young's modulus of 85 infants within 60 days who were suspected with cholestatic hepatitis.All the patients were classified into BA group and non biliary atresia (Non-BA) group according to surgical or pathological results.At the same time,45 normal infants within 60 days were selected as the control group.The hepatic Young's modulus were compared among the 3 groups.The sensitivity and specificity of hepatic Young's modulus in suspected BA patients were calculated by ROC.Results In the 85 cases,42 cases were diagnosed as BA,and 43 cases were classified as Non-BA group.The Young's modulus values of the 3 groups were as follows:BA group (15.86 ± 5.89) kPa,Non-BA group (10.89 ± 2.38) kPa,and control group (6.64 ± 0.53)kPa,with a significant difference among the 3 groups(P ＜0.01).The ROC analysis showed a cut off value of 12.9 kPa for differentiation between BA group and Non-BA group.The area under ROC curve (AUROC) was 0.787,with a sensitivity of 59.5％ and a specificity of 88.4％.Conclusions The young's modulus in BA patients can be increased at early time,and the SWE technique can be used to reflect the change of hepatic Young's modulus accurately,which will be helpful in the early differential diagnosis of BA.

Objective:To investigate the changes of related indicators of right heart hypofunction in patients with primary myelofibrosis (PMF).Methods:The clinical data of 55 PMF patients in the Second People's Hospital of Lianyungang in Jiangsu Province and Jiangsu Province Hospital from January 2015 to August 2019 were retrospectively analyzed. The differences in right heart function-related echocardiographic indexes and biochemical indexes between pre-fibrosis/early stage fibrosis patients and obvious stage fibrosis patients were compared. Single factor linear regression method was used to analyze the correlations of pulmonary artery pressure with biochemical indexes.Results:The hemoglobin level [119 g/L (47-224 g/L) vs. 78 g/L (33-182 g/L)] and platelet count [233×10 12/L (5×10 12/L-984×10 12/L) vs. 117×10 12/L (7×10 12/L-731×10 12/L)] of patients in the pre-fibrosis/early stage fibrosis group were higher than those in the obvious stage fibrosis group, and the differences were statistically significant (both P<0.05). Among 22 patients with complete results of cardiac ultrasound, 90.9% (20/22) patients had increased pulmonary artery pressure, 72.7% (16/22) patients had increased left atrial diameter, and 90.9% (20/22) patients had increased right ventricular diastolic diameter. There were no patients with abnormal ejection fraction. The pulmonary artery pressure [48 mmHg (46-90 mmHg) vs. 33 mmHg (20-50 mmHg) (1 mmHg = 0.133 kPa)], left ventricular diastolic diameter [46 mm (36-50 mm) vs. 47 mm (43-53 mm)] and fractional shortening rate [38.1% (36.0%-38.9%) vs. 35.4% (32.7%-37.8%)] of patients in the pre-fibrosis/early stage fibrosis group were higher than those in the obvious stage fibrosis group, and the differences were statistically significant (all P < 0.05). The pulmonary artery pressure of patients had positive correlations with age ( r = 0.590), serum ferritin (SF) ( r = 0.608), lactate dehydrogenase (LDH) ( r = 0.711) and soluble growth-stimulating expression gene 2 (ST-2) ( r = 0.580)(all P<0.05), and had negative correlation with platelet count ( r = -0.596, P = 0.003). Conclusion:PMF patients are prone to right heart hypofunction, the pulmonary artery pressure is higher in older patients and patients with high SF, LDH and ST-2 levels and low platelet count.

Objective: To explore the moderating role of estradiol in the relationship between parenting styles and preschool children's behavioral problems, so as to provide a theoretical basis for improving the development of human s emotional health development in early life stage. Methods: During September to November in 2022, 354 children aged 3-6 years and their parents from two kindergartens in Bengbu City were chosen by using stratified cluster sampling method for the questionnaire survey. The Parenting Style Scale and the Child Behavior Checklist (CBCL) were used to collect information on parenting style and child behavioral problems. Salivary estradiol of children was collected and tested. Independent samples t test was applied to compare the scores of the scale for parental up bringing and children s behavioral problems, and Pearson correlation analysis was conducted to explore the relationship among parental upbringing, estradiol and children s behavioral problems. Results: Parents doting, laissez faire, autocratic, and inconsistent parenting styles were positive associated with child behavior problems( r =0.14-0.70); fathers democratic parenting style was negatively associated with child behavior problems( r =-0.14，-0.22，-0.21，-0.17，-0.27，-0.20); mothers democratic parenting styles was negatively correlated with scores on all five dimensions of child behavior problems except the withdrawal dimension ( r =-0.14，-0.12，-0.13，-0.21，-0.12)( P <0.05). Estradiol levels had significant moderating effects on maternal doting parenting style and children s withdrawal ( β =0.68) as well as social problems ( β =-1.00), also moderating laissez faire parenting styles and children s withdrawal problems ( β =0.75)( P <0.05). For children with low levels of estradiol, withdrawal problem scores were negatively associated with mother s doting parenting style and positively associated with laissez faire parenting style, and socialization problem scores were associated with mother s doting parenting style; for children with high levels of estradiol, withdrawal problem scores were positively associated with mother s doting parenting style, and socialization problem scores were associated with mother s doting parenting style ( t=2.84, 6.24, 3.16 , 2.37, 4.49, P <0.05). Conclusions Parenting styles are strongly associated with child behavioral problems; estradiol levels play a moderating role in mothers doting, laissez faire parenting styles and children s withdrawal problems and social problems.Parents should adopt more positive parenting styles and focus on the role of estradiol levels in maternal education to reduce the occurrence of behavioral problems in children.