In April 2016,the American Geriatrics Society(AGS)entered into a cooperative agreement with U.S.Department of Transportation.National Highway Traffic Safety Administration (NHTSA) updates and expands the Clinician's Guide to Assessing and Counseling Older Drivers to the 3rd Edition.The main goal of the Guide is to reduce traffic accidents and injuries to older drivers.According to the workflow of evaluation and management provided by Plan for Older Driver Safety(PODS),clinicians can conduct driving strategies after screening,evaluation and result analysis.The evaluation is done based on the Clinical Assessment of Driving Related Skills(CADReS) by a team including physicians,nurse practitioners,physician assistants,pharmacists,occupational therapists,driving rehabilitation specialists,and social workers.The CADReS including a series of assessment tools are used to evaluate in the key areas,such as vision,cognition,and motor/sensory function related to driving.Some measures will be taken based on the evaluation conclusions to help to explore the potential of driving safely for old adults.

Objective With generalization and steadiness,a new evaluation model by Integrating Non Linear Features extraction algorithm with artificial neural networks(ANN) used for pattern recognition of quality control of Radix Paeoniae Alba was proposed in this paper.Methods The HPLC data from 29 samples with different quality were proceeded with nonlinear kernel principal component analysis(KPCA) and an improved Back propagation algorithm of ANN.The extract characteristics was fed into BP neural networks as input elements for pattern recognition.In the meantime,the processing data,the optimal numbers of hidden layers,the numbers of hidden nodes,excitation functions,and over-fitting,etc. were discussed wholly so that standardization networks was designed without jamming.Results As recognition ratio was 100%,the pattern recognition of quality control of Radix Paeoniae Alba was established successfully by trained networks and predicted results.Conclusion Integrating KPCA algorithm with ANN for pattern recognition of quality control of Radix Paeoniae Alba has been proved to be available.

Objective To investigate the incidence and risk factors of adverse drug reactions in hematological system induced by linezolid.Methods In this retrospective study, 124 inpatients treated with linezolid (n=62) or vancomycin (n=62) for anti-infective therapy between January 2012 and December 2015 in clinical departments of the Second Affiliated Hospital of Anhui Medical University were included.The incidence hematological adverse drug reactions were observed, and the single factor and the multiple factor Logistic regression methods were used to analyze the risk factors of developing thrombocytopenia and decline of hemoglobin.Results Among the 62 inpatients treated with linezolid, thrombocytopenia occurred in 21 patients(33.87%), and decline of hemoglobin occurred in 17 patients (27.42%).No patient discontinued the use of linezolid for the reason of thrombocytopenia or decline of hemoglobin.In multiple stepwise regression analysis, linezolid use[OR=7.699,95%CI (1.408,42.090),P=0.019], treatment duration>14 d[OR=7.639,95%CI(1.162,50.226),P=0.034], baseline eGFR<80 mL·min-1[OR=6.150,95%CI(1.604,23.577),P=0.008], baseline ALB<25 g·L-1[OR=4.078,95%CI(1.017,16.351),P=0.047] and baseline platelet count<200×109·L-1[OR=6.148,95%CI(1.705,22.172),P=0.006] were independent risk factors for thrombocytopenia;linezolid use [OR=4.335,95%CI(1.308,14.365),P=0.016] and baseline ALB<25 g·L-1[OR=5.424,95%CI(1.824,16.129),P=0.002] were independent risk factors for the decline of hemoglobin.Conclusion The incidences of thrombocytopenia and anemia induced by linezolid are not rare, and most of them can be returned to normal.The risk factors of thrombocytopenia and anemia should be concerned and the routine blood test should be monitored during use.

Aim To observe the effects of cytokine signaling inhibition protein-3(SOCS3) on the liver fibrosis progression and reverse.Methods C57BL/6 mouse model was established by subcutaneous injection of carbon tetrachloride(CCl4).After a successful model of fibrosis, one-month normal diet was given to induce the reverse fibrosis model, while normal mice of the same gender and weight were as control group.Mice were sacrificed at 1, 2, 3, 4, 5, 6, 7, 8 weeks, respectively, then the liver tissue was harvested for the observation of its injury by hematoxylin and eosin(HE) staining.Then Masson staining was applied for the detection of changes in collagen, and the immunohistochemistry(IHC) for the observation of type Ⅰ Collagen(Colla-1), alpha smooth muscle actin(α-SMA), transforming growth factor beta 1(TGF-β1) and SOCS3 protein expression.In vitro formation of fibrosis was induced by TGF-β1 stimulating HSC-T6 cell lines, which was then reversed by MDI medium, with co-incubation of HSC-T6 cells with plasmid in the process of the reverse.Western blot was employed to detect SOCS3, Colla-1, α-SMA, TGF-β1 expression.Results The expression of SOCS3 and TGF-β1 increased in mouse model of fibrosis with the worsening fibrosis process and decreased in the reverse process.Over-expression SOCS3 in the reverse process reduced the development of liver fibrosis;meanwhile, the expression of TGF-β1 was also reduced accordingly.Conclusion SOCS3 may influence the development of the liver fibrosis and its reverse via regulating the expression of TGF-β1.

Objective: To educate the high-quality nurses with ability and to improve their capability in holistic nursing.Methods: Interlocution of nursing case is applied to theory teaching.Clinic probation and simulative act are applied to practical teaching.Results:Situational teaching method is welcome among the experimental students whose grade is higher than that of the students of contrast class.Conclusion: It is propitious to education in synthesis ability of students to use situational teaching method based on the holistic nursing.

Purpose To explore the significance of MR diffusion tensor imaging (DTI) in diagnosing and predicting the motor function of patients with acute ischemic stroke in the brainstem. Materials and Methods Twenty patients with acute ischemic stroke in the brainstem and 20 normal controls were enrolled in the study. DTI was performed on all 40 subjects. Fractional anisotropy (FA) in specific regions were measured including infarction lesions, cerebral peduncle, the posterior limb of the internal capsule in the affected side and corresponding unaffected regions. The number and the length of the corticospinal tracts (CST) of both affected and unaffected sides were also measured. The correlation of FA, the number and the length of the CST, the NIH stroke scale (NIHSS) at the admission, 3 months and 6 months was analyzed. Results The FA values of infarction, cerebral peduncle, and the posterior limb of the internal capsule, and the number of CST in the affected side were significantly less than that of the corresponding unaffected regions (P<0.05). The rFA (<7 d) in the affected cerebral peduncle was negatively correlated with NIHSS and the score of the upper and lower extremity muscle strength at the admission, after 3 months and after 6 months (P<0.05). However, the rFA of the infarction and the posterior limb of the internal capsule, the ratio of the number and the length of CST of affected/unaffected sides had no correlation with NIHSS score and the score of the muscle strength. Conclusion The rFA in the cerebral peduncle is helpful for early evaluation and predicting recovery of the motor function in the patients with acute ischemic stroke in the brainstem.

Objective To investigate the effects of peptidoglycan (PGN) with different concentrations on Toll-like receptor 2 (TLR2),Toll-like receptor 4 (TLR4) expression in corneal epithelial cells of mice.Methods Corneal epithelial cells of c57 mice were cultured in vitro.Cells were divided into blank control group and 10 mg · L-1 group,30 mg · L-1 gruop and 80 mg · L-1 group (treated by different concentration of PGN for 12 hours).In the meantime,the cells in 30 mg · L-1 group were cultured for different times(named 12 hours group,24 hours group,36 hours group).Expressions of TLR2 and TLR4 mRNA and protein in different group were measured by RT-PCR and flow cytometry.Results Compared with control group (1.00 ± 0.14,1.00 ± 0.01),the expression of TLR2,LR4 mRNA in 10 mg · L-1 group (4.35 ± 0.46,3.53 ± 0.50),30 mg · L-1 group (8.06 ±0.72,5.31 ±0.34),80 mg · L-1 group (2.93 ±0.46,2.23 ±0.04) were increased,the differences were statistically significant (all P ＜ 0.05).Compared with control group,the expression of TLR2,TLR4 protein in different concentration group and 12 hour group were increased,the differences were statistically significant (all P ＜ 0.05).Conclusion PGN can up-regulate both mRNA and protein expression of TLR2 and TLR4 in corneal epithelial cells of mice,suggest that TLR2 and TLR4 in the corneal epithelial cell can recognize some exogenous pathogen and regulate the inflammatory reaction,which are closely related to the occurrence and development of infectious keratitis.

Lysozyme, pepsin, ovalbumin, hemoglobin andγ-globumin were chosen as templates to investigate the imprinting capability of amphoteric polyacrylamide cryogels. Prepolymerizing solutions contained acrylic acid and allyl amine, as well as acrylamide and N,N'-methylenebisacrylamide as the functional monomers. As a result there were both acidic and basic functional groups in the polymers, facilitating effective interactions with likewise amphoteric proteins. The proteins differ greatly and cover wide scopes of molecular weights and isoelectric points. Regardless of the values of the molecular weights and isoelectric points, all the templates gave higher retentions on the MIP tubes than on the NIP tube. The MIP of lysozyme indicated the highest imprinting factor of 7. 0, and that of γ-globumin showed the lowest, 2. 0. The values of other proteins were intervenient. Conclusively the amphoteric polyacrylamide cryogels were suitable imprinting materials for various proteins, and could potentially be used for protein recognition, purification, and depletion.

Objective To investigate the image quality and radiation dose of automatic spectral imaging mode selection and adaptive statistical iterative reconstruction (ASIR) at abdominal CT with low contrast agent dose. Methods One hundred cases with the arterial-phase (AP) and portal venous phase (PVP) contrast-enhanced abdominal CT scanning were analyzed prospectively. Patients were randomly assigned to the study group and control group (n=50 each). In the study group, automatic spectral imaging mode selection and contrast agent dose of 300 mg/kg were used and spectral monochromatic images(40 to 60 keV) were reconstructed using either filtered back-projection (FBP) (group A) or ASIR (group B). In the control group, the fixed tube potential of 120 kVp and contrast agent dose of 450 mg/kg were used with images reconstructed using FBP (group C). Quantitative parameters (image noise and contrast-to-noise ratio of the liver, pancreas, aorta and portal vein) and qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared among the groups by using One-way ANOVA or Kruskal-Wallis H test. Two sample t tests were used compare the radiation dose difference. Results There had no significant difference in CTDIvol[both (12±5) mGy] and DLP[(364±142) mGy·cm versus (377±131) mGy·cm] between the study group and control group(t=-0.408 and-0.428,P>0.05). During the AP and PVP, at the energy level of 40 keV, group B showed higher CNRs than group A and group C, lower image noise[ (29±6) HU in AP, (24±6) HU in PVP] than group A[(43±11) HU, (44±10) HU] but higher image noise than group C[ (18± 4) HU, (18±4) HU], lower overall image quality scores[(3.0±0.2) point, (2.9±0.3) point] than group C[(3.6± 0.4) point , (3.6±0.5) point] but similar scores to group A[(2.9±0.4) point,(2.8±0.4)point]. At the energy level of 50 keV, group B showed higher CNRs than group A but higher than or similar CNRs to group C, lower image noise[ (20±5) HU, (20±4) HU] than group A[(31±8) HU, (31±7) HU] but similar image noise to group C, higher overall image quality scores[(3.6±0.4) point, (3.5±0.4) point]than group A[(3.3±0.3) point,(3.3±0.3) point] but similar scores to group C. At the energy level of 60 keV, group B showed lower image noise[(14±4) HU, (14±3) HU], higher CNRs and overall image quality scores[(3.9±0.4) point,(3.9±0.3) point] than group A[(19 ± 5) and (20 ± 5)HU in image noise, (3.7 ± 0.4) and (3.7 ± 0.3) point in overall image quality scores ]and group C. Except for monochromatic images at 40 keV, the overall image quality scores in group B were all greater than 3 point and met the clinical diagnostic level. Conclusions The radiation dose of CT spectral imaging and conventional 120 kVp CT scan is equivalent with the use of automatic spectral imaging mode selection. By combining ASIR technique, monochromatic images at 50 and 60 keV can improve CNR and reduce contrast agent dose while maintain or improve overall image quality.

Objective To evaluate the CT spectral imaging in assessing the therapeutic efficacy of axitinib in rabbit VX2 liver tumors. Methods Thirty-two VX2 liver tumor-bearing rabbits (diameter 1.0 to 2.5 cm) were prospectively and randomly assigned into the study group (axitinib treated group, n=16) or the control group (pseudo-therapy group, n=16). They were treated with axitinib or saline by using the gastric tube respectively. All the rabbits underwent unenhanced, arterial-phase (AP) and portal-phase (PP) contrast enhanced CT examinations by using spectral CT at different time points (baseline, 2, 4, 7, 10 and 14 days after treatment). Tumor size (TS) at each time point was recorded to calculate the percentage change (ΔTS)after treatment relative to baseline. Iodine concentration (IC) of the entire tumor, the peripheral hypervascular region and the center of the tumor were measured and normalized to aorta (NIC) to generate the difference for the NIC (NICD) between a given time and baseline. The tumorΔTS and NICD between the control and treated groups were compared by using Mann-Whitney U test. Serial changes in NICD at different time points were evaluated by using Wilcoxon signed rank test. Correlations between the NICD andΔTS, between NIC and microvessel density (MVD) were analyzed. Results The tumorΔTS after treatment in the control group and study group increased continuously. The tumorΔTS was significantly smaller in the treated group than that in the control group at day 7, 10 and 14. At day 2 , 4 and 10 after treatment, each tumor NICD in the study group was smaller compared with the control group(P<0.05)except the NICD in the entire tumor and the center of the tumor in AP at day 4 , in the entire tumor in PP and the peripheral hypervascular region of the tumor in AP at day 10; no significant differences were found between the two groups at day 7 and day 14 except the NICD in the entire tumor in PP. The tumor ΔTS at day 14 after treatment was (41.44 ± 5.48) %. The tumor NICD in the entire tumor at day 2 in the two phases and the peripheral hypervascular region of the tumor in AP were positively correlated with ΔTS at day 14 (r=0.692, 0.521 and 0.639, P=0.002, 0.032 and 0.005, respectively). The tumor NICD in the peripheral hypervascular region of the tumor in AP were positively correlated with ΔTS at day 14(r=0.673,P=0.003). The tumor NIC values in the entire tumor, peripheral hypervascular region and the center of the tumor in the two phases at day 7 and day 14 had positive correlations with MVD (r=-0.69 to 0.72, all P values<0.05) except the NICD in the center of the tumor in PP (P>0.05).Conclusion CT spectral imaging allows the evaluation and early prediction of tumor response to axitinib in rabbit VX2 liver tumors.