Collateral circulation actively enables or generates new blood vessels in order to ensure blood supply to the tissues of body when the normal feeding arteries are stenosis or occlusion.This article mainly reviews the assessment methods of collateral circuhtion in ischemic stroke.

Objective To investigate a repair method for unilateral complete cleft lip nasal deformities.Methods Based on the fullness of healthy nasal wing,Z-form plasty was designed with a nasal mucous membrane and alar cartilage flap,to prolong its curtate length of the deformed side through overlapping transposition,and then with suspension of the custom-crafted nasal wing to replace its abnormal structure,subsequently,to recover the normal anatomic structure of the nosewing,and to get the nasal deformity repaired.Results A total of 12 patients with the severe nasal deformity were treated by this method.and all had satisfactory results.Conclusion This technique is a good choice for repairing the severe secondary nasal deformity after single complete cleft lip operation.

Objective To explore the factors affecting urinary arsenic methylated metabolites in population exposed to elevated arsenic through drinking water.Methods Residents,including 73 males and 72 females,in a endemic village located in Inner Mongolia Autonomous Region where the concentration of arsenic in drinking water was 0.167 mg/L,were included in the study; moming urine samples were collected; individual height and weight were measured which could be used to calculate body mass index(BM庆) ; and smoking and drinking habit was investigated by a questionnaire survey.Urinary concentrations of inorganic arsenic (iAs),monomethylarsenic acid(MMA) and dimethylarsenic acid(DMA) were determined using high performance liquid chromatography hydride generation atomic fluorescence spectrometry (HPLC-HG-AFC).Total arsenic (T-As) level was calculated by the sum of iAs,MMA and DMA; iAs％,MMA％ and DMA％ was calculated based on iAs/T-As,MMA/T-As and DMA/T-As.One methylation ratio(PMI) and dimethyl rate(SMI) were calculated by MMA/iAs and DMA/MMA.Results SMI level of female was significantly higher than that of male [median (M) =4.18,3.38,x2 =11.219,P ＜ 0.05] ; MMA％ of female was significantly lower than that of male(M =15.1 9,18.06,x2 =9.272,P ＜ 0.05) ; DMA％ of female was significantly higher than that of male (M =65.61,59.47,x2 =11.728,P ＜ 0.05).Various forms of arsenic indexes were not affected by smoking,alcohol consumption and BMI(P ＞ 0.05).BMI was negatively correlated with MMA％,with correlation coefficient (r)-0.17 (P ＜ 0.05).Conclusions Under the same condition of arsenic exposure,arsenic methylation capacity of women is higher than that of men.Lower BMI is significantly associated with higher methylation capability of arsenic,but this correlation may be affected by other confounding factors.

Objective:To understand the relationship between psychiatric nurses' communication ability, personality characteristics and conflict management patterns, and to provide a basis for training psychiatric nurses' conflict management ability courses.Methods:A convenient sampling method was used to investigate and investigate 208 nurses in the first-line clinical hospitals of a third-class psychiatric hospital, used the nurses′ clinical communication ability scale, the nurse′s interpersonal conflict management morphology scale, and the simplified version of the Chinese Big Five Personality Questionnaire.Results:Integration dimension (18.67±2.58) points, concession dimension (12.93±2.43) points, escape dimension (14.05±2.02) points, dominance dimension (14.49±3.06) points, and integration dimension and gender ( t value was -2.57, P=0.01)), education ( F value was 3.76, P=0.02), technical title ( F value was 3.03, P=0.02), position ( t value was 2.08, P=0.03), whether to participate in nurse-patient communication training ( t value was 2.54, P=0.02). Nurses with pleasant personality could better deal with interpersonal conflict ( r=0.361, P<0.01), and the nurse′s personality had a direct effect on the form of interpersonal conflict ( P=0.036, 95% CI 0.107-0.422), the nurse′s communication ability plays a part of indirect effect ( P=0.031, 95% CI 0.001-0.063). Conclusion:The form of interpersonal conflict management of psychiatric nurses was closely related to communication ability and personality characteristics. Nursing managers could carry out targeted training to improve the conflict management ability of nursing staff.

Objective: To investigate the influencing factors of nosocomial infections among patients undergoing radiotherapy, so as to provide insights into nosocomial infection control among radiotherapy patients. Methods: The malignant tumor patients receiving radiotherapy in Yiwu Central Hospital from 2019 to 2020 were selected. Their demographic features, radiotherapy and nosocomial infections were collected through the eletronic medical records. The factors affecting nosocomial infections were identified among radiotherapy patients using a multivariable logistic regression model. Results: Totally 553 malignant tumor patients receiving radiotherapy were enrolled, including 268 men ( 48.46% ) and with a mean age of ( 60.31±13.66 ) years. The mean duration of hospital stay was ( 28.67±14.32 ) days, and the mean radiotherapy cycle was ( 3.63±1.89 ) weeks. A total of 46 patients were detected with nosocomial infections, with prevalence of 8.32%. The top three sites with the highest prevalence of nosocomial infections included the lower respiratory tract ( 14 cases, 30.43% ), oral cavity ( 10 cases, 21.74 ) and urinary tract ( 8 cases, 17.39% ), and 42 bacterial strains were isolated, with Gram-negative bacteria as the predominant strains ( 25 strains, 59.52% ). Multivariable logistic regression analysis showed that radiotherapy cycle of 4 weeks and longer ( OR=3.857, 95%CI: 1.896-7.846 ), radiotherapy exposure ( OR=3.254, 95%CI: 1.561-6.783 ), arteriovenous catheterization ( OR=2.165, 95%CI: 1.144-4.098 ), urinary tract intubation ( OR=6.028, 95%CI: 1.841-19.734 ) and poor nutritional status ( OR=3.933, 95%CI: 1.493-10.360 ) were associated with nosocomial infections among radiotherapy patients. Conclusion Radiotherapy cycle, exposure to radiotherapy, arteriovenous catheterization, urinary tract intubation and poor nutritional status are factors affecting nosocomial infections among radiotherapy patients.

Objective To evaluate prognostic value of pentraxin3 (PTX3) content combining with extravascular lung water index (EVLWI) in patients with sepsis.Methods A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted.These patients were divided into two groups,survival group and death group,according to the outcome on the 28th day.Pulse index continuous cardiac output (PiCCO) was used to record the levels of EVLWI on the 1st,2nd and 3rd day of intensive care unit (ICU) admission.The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay (ELISA).At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) were calculated.Correlation analysis between plasma PTX3 and EVLWI values was performed,receiver operating characteristic curve (ROC) was drawn,and the prognostic value of each parameter was assessed finally.Results A total of 74 septic patients were enrolled,with 41 cases in the survival group and 33 cases in the non-survival group.Blood lactate,APACHE Ⅱ,SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission,and the length of ICU stay was significantly shorter than that of the survival group,while differences of the other clinical characteristics between two groups were not statistically significant.The plasma PTX3 level gradually declined with time in both groups,and plasma PTX3 at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [PTX3 (μg/L) at 1 day:46.3± 10.5 vs.19.4±6.5,t =-13.486,P =0.000; 2 days:34.8± 10.7 vs.17.7±8.4,t =-8.284,P =0.000; 3 days:23.9± 11.2 vs.15.6 ± 7.9,t =-5.036,P =0.000].EVLWI gradually declined in survival group,but increased in death group.EVLWI at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [EVLWI (mL/kg) at 1 day:12.12 ± 4.31 vs.10.02 ± 2.87,t =-2.502,P =0.023; 2 days:13.67 ± 4.95 vs.9.08 ± 2.89,t =-5.188,P =0.000; 3 days:14.51±5.06 vs.8.09±2.50,t =-7.126,P =0.000].PTX3 at 1,2,3 days after ICU admission showed a significant positive correlation with EVLWI (r1 =0.747,r2 =0.719,r3 =0.705,all P =0.000).ROC curve analysis showed that the area under the ROC (AUC) of PTX3 at 1 day was 0.845 ± 0.045,at the cut-off point of 23.0 μg/L,PTX3 showed a sensitivity of 84.8％,a specificity of 74.1％,a negative predictive value of 85.81％,and a positive predictive value of 72.42％.AUC of EVLWI at 3 days was 0.838 ± 0.048,at the cut-off point of 10.5 mL/kg,EVLWI showed a sensitivity of 83.9％,a specificity of 82.9％,a negative predictive value of 86.45％,and a positive predictive value of 79.79％.Their sensitivities and specificities were found to be better than APACHE Ⅱ,SOFA score.AUC of PTX3 combined with EVLWI at 1 day was 0.886 ± 0.038.On the 1st day after ICU admission,with combination of the two indicators,cut-off point was found to be 0.312,a sensitivity of 86.8％,a specificity of 85.4％,a negative predictive value of 88.93％,and a positive predictive value of 82.72％.On the 3rd day after ICU admission,AUC of PTX3 combined with EVLWI was 0.856 ± 0.046,and showed a cut-off of 0.471 for the prognosis of sepsis,a sensitivity of 85.8％,a specificity of 85.4％,a negative predictive value of 87.97％,and a positive predictive value of 82.50％.Compared with other single index,a combination of above mentioned two indexes showed a better sensitivity and specificity.Conclusions PTX3 can serve as a novel prognostic indicator at early stage in septic patients.Combined with EVLWI,it shows important value in predicting prognosis of septic patients,and it also provides guidance in treatment of high-risk patients.

Objective:This study aimed to explore the effects ofnesfatin-1 on gastric distension (GD)-sensitive neurons in the basomedial amygdala (BMA) and the potential mechanism for nesfatin-1 to regulate gastric motility through the arcuate nucleus (Arc).Methods:The projection of nerve fiber and expression of nesfatin-1 were observed by retrograde tracing and fluo-immunohistochemistry staining;The nuclei microinjection and nuclei electrical stimulation,extracellular discharges of single unit neuron were used to observe the effects ofnesfatin-1 on the GD neurons;Gastric motility recording in vivo were used to monitor the effects ofnesfatin-1 on the amplitude of constriction and frequency of gastric motility in conscious rats.Results:NUCB2/Nesfatin-1/fluorogold-double labeled neurons were from ARC to BMA;Nesfatin-1 could excited the firing rate of most of the GD-E neurons (4.25± 1.02 Hz vs.5.32± 1.17 Hz,P＜0.01) and decreased the firing rate of most of the GD-I neurons (3.73± 0.92 Hz vs.2.64± 0.86 Hz,P＜0.01),inhibited the gastric motility,amplitude and frequency,SHU9119 could weaken the responses induced by nesfaton-1;Electrical stimulation of the Arc,the firing rate of nesfatin-1-induced GD-response neurons (GD-E:5.14± 1.32 Hz vs.6.75± 1.84 Hz,P＜0.05;GD-I:2.84± 0.86 Hz vs.4.05± 1.12 Hz,P ＜0.05) and the gastric amplitude and frequency were increase.Conclusion:It was suggested that nesfatin-1 in the BMA plays an important role in decreasing gastric motility and the Arc may be involved in this regulation process.

Objective This article analyzed the characteristics of the health service in medium cities and the impact on community health service.Methods Summary and statistical analysis of the outcomes from the Fourth National Health Service Survey by the category of metropolitans,sub-provincial cities and provincial capital cities,and non-provincial-capital cities.Results In the medium cities,the geographical accessibility is high against low economic and technology accessibility.These cities have lower 2-week morbiditv rate but high children morbidity rate.These cities also feature high self-rated health status among residents and high health risk factors prevalence at the sarne time.Conclusion Medium cities are recommended to further build their CHS system,enhance their ties with larger cities,so as to elevate their technical competence,for meeting such public health needs of the people in infectious disease control,health promotion and vulnerable population healthcare.

SUMMARY Delayed postoperative spinal epidural hematoma(DPSEH) is a rare and potentially devastating complication of laminoplasty, and cervical nerve root palsy occurs more frequently than DPSEH, especially with C5 nerve root palsy. The authors describe a case of DPSEH with C5 nerve root palsy that developed in a patient 3 days after he underwent laminoplasty. In this case, a 78-year-old man with a history that having taken Aspirin without the doctor’s instruction for 5-6 years,he underwent cervical laminoplasty for mild myelopathy. On the 3rd postoperative day, he complained of weakness of his left upper extremity and could not raise his left arm. The symptom aggravated in the next few days. On the 9th postoperative day, there was an obvious motor deficit of both upper and lower extremities. Magnetic resonance imaging demonstrated abnormal signal characteristics consistent with a hematoma at levels C3-C4, compressing spinal cord. The clot was evacuated during emergency revision surgery, and the postoperative course after the operation was uneventful and the muscle strength was improved five days later. Therefore, the symptoms of DPSEH are not so typical that its possibility should be kept in mind. Sometimes a differential diagnosis should be made with C5 nerve root palsy which may only represent weakness of upper extremities. The authors recommend that magnetic resonance imaging is helpful for the diagnosis of DPSEH and a revision surgery should be taken as soon as possible once the hematoma causing the neurologic deterioration was confirmed.

Objective To find out the expression relation between TP53 and NOTCH1,and to explore their effects in head and neck squamous cell carcinoma.Methods Obtained the differentially expressed genes data of head and neck squamous cell carcinoma from 279 samples in TCGA database.Analyzed the co-expression relation between TP53 and NOTCH1 through Pearson and Spearman method.Cbioportal was used to analyze their co-expressed genes.Establish the co-expression network of TP53 and NOTCH1 with String database.The pathway and function of co-expression network was identified through KEGG and DAVID database respectively.Results Among the 279 samples,TP53 and NOTCH1 was co-expressed in head and neck squamous cell carcinoma.(Pearson score =0.45;Spearman score =0.41) There were 182 interaction pairs of TP53 and NOTCH1 related co-expressed gene according to the String database.(Pearson and Spearman score ＞ 0.3)These genes were enriched in some pathways such as T cell receptor signaling pathway,cell cycle,cell adhesion molecules and so on.These genes were enriched in some tumor related function including immune response,regulation of transposition,regulation of apoptotic process,cell cycle,regulation of GTPase activity and so on.Conclusion TP53 and NOTCH1 was co-expressed.Through establishing co-expressed network of TP53 and NOTCH1 and bioinformatics analysis,their function and signaling pathway were explored.The data generated from this study could provide a new reference in mechanism research of head and neck squamous cell carcinoma.