Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic tuberculosis.Methods The study was retrospective,from September 2009 to September 2012,38 patients who underwent EBUS-TBNA were finally diagnosed of thoracic tuberculosis,with enlarged hilar or mediastinal Iymph nodes on chest enhanced computed tomography(≥ 1.0 cm).Patients in whom EBUS TBNA was nondiagnostic subsequently underwent surgical biopsy.All the patients had a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 88 lymph node stations in 38 patients.Of the enlarged lymph nodes,60(68.18％) were located in the mediastinal region and the remaining 28 (31.82 ％) around the hilum or interlobar area.Of the 38 patients,EBUS-TBNA achieved definitive diagnosis in 34 patients(89.47％).EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic tuberculosis.

OBJECTIVETo assess the influence of assisted reproductive technology(ART) on the incidence of fetal chromosomal abnormalities by analyzing spontaneous abortions during the first trimester following natural conception(NC) or assisted reproductive technology(ART).

METHODSThree hundred and fourteen chorionic villus samples of women with first trimester spontaneous abortion were collected. Cell culture and G-banding karyotyping analysis were carried out, which included 125 cases by in vitro fertilization(IVF), 87 cases by intracytoplasmic sperm injection(ICSI) and 102 cases by natural conception(NC).

RESULTSChromosomal aberrations were found in 167(53.2%) of the 314 cases. No significant difference was found in the spectrum of karyotypic abnormalities between NC and ART groups. The incidence of chromosomal abnormalities has increased along with the maternal age. Compared with the fresh embryo-transfer(ET) group, frozen-thawed embryo transfer(FET) group showed a slightly lower incidence of chromosomal abnormalities, albeit with no statistical significance(47.3% vs. 53.8%, P>0.05).

CONCLUSIONFetal chromosomal abnormalities are the main cause for spontaneous abortion during the first trimester regardless the ways of conception. Their incidence is associated with maternal age. FET is relatively safe as well as fresh ET. ART is a relatively safe treatment which does not increase the rate of fetal chromosomal abnormalities.

The obstruction of kidney collaterals by turbid and blood stasis is a characteristic pathogenesis of gouty nephropathy,which runs throughout the whole process of the disease.The pathogenesis of disease of gouty nephropathy is different from that of other chronic kidney diseases,determines the occurrence and development direction of patterns and symptoms,and is the common pathogenesis behind different patterns.The pathogenesis of pattern is the main body of pattern differentiation and treatment of gouty nephropathy,damp-heat obstruction and spleen-kidney deficiency and is the pathogenesis base of same treatment for different diseases.The pathogenesis of symptoms is a direct pathogenesis induced by symptoms.In treatment of gouty nephropathy,symptomatic treatment can improve the therapeutic effects based on disease and pattern differentiations.

Objective:Previous studies have found that Qidi Tangshen granules (QDTS),a combination therapy of supplementing essence (Tianjing,TJ) and unblocking the collaterals (Tongluo,TL),can reduce kidney damage in db/db mice.This study aimed to explore the effect of QDTS and their separate prescriptions on podocytes in mice with diabetic nephropathy.Methods:The db/db mice were used in this experiment as an animal model,while wild-type C57BL/6J mice were used as normal controls.At the age of 12 weeks,the db/db mice were randomly divided into 5 groups (db/db,db/db + valsartan,db/db + QDTS,db/db + TJ and db/db + TL).The urine albumin excretion ratio (UAE) was measured by enzyme-linked immunosorbent assay before and after the intervention.The ultrastructure of the kidney podocytes was observed by transmission electron mi-croscopy.The protein expression levels of nephrin and desmin were detected by immunohistochemistry.Results:QDTS and their separate prescriptions significantly decreased the UAE and attenuated the renal pathological injury.QDTS and their separate prescriptions also reduced the fusion rate of the foot pro-cesses and increased the expression of nephrin protein.In contrast,QDTS and their separate pre-scriptions (TJ and TL) reduced the expression level of desmin protein.Conclusion:QDTS and their separate prescriptions might reduce diabetes-induced renal injury by reducing podocyte damage.The therapeutic effect of QDTS was more pronounced than TJ and TL.

ObjectiveTo analyze the main types of the leadership in the charge nurses in ClassⅢ general hospitals by the potential category model, so as to explore the management training needs for the different types of charge nurses. MethodsBy cluster random sampling, charge nurses from 11 ClassⅢgeneral hospitals in Zhejiang province were selected from October to December of 2017 and studied by General Information Questionnaire, Leadership Questionnaire, and Training Needs Questionnaire. By Mplus 7.0 software, the potential category model of charge nurses＇ leadership was analyzed and all categories of charge nurses＇ training needs were analyzed by SPSS 19.0 software. Totally 782 questionnaires were collected with 736 valid ones left after omitting the invalid ones, yielding an effective recovery rate of 94.12%. ResultsPotential category model analysis showed that in the 736 charge nurses, 3 leadership categories of high level of leadership, medium level of leadership and low level of leadership accounted for 12.64%,55.84% and 31.52% respectively. The charge nurses had high demands on management position training, with each clauses exceeding 3.50 points, there were statistical differences in the 3 potential leadership categories of charge nurses＇training demands as well as scores from each clauses(P＜ 0.05). There were no statistical difference between each categories in terms of the training needs of "nursing quality management","hospital infection management""occupational protection" "computer application skills" "human resource management" and "scheduling as well as basic qualify and abilities" (P＞0.05). ConclusionsThere are 3 types of leadership in the charge nurses of the Class Ⅲ general hospitals. The clauses with high demands among the nurses with low level of leadership include "nursing quality management" "nursing safety management"; the clauses with high demands among the nurses with medium level of leadership include "staff stimulation and talent cultivation" "nursing safety management"; the clauses with high demands among the nurses with high level of leadership include "strategic management setup" "leadership improvement", etc.

Objective? To explore the effect of staged group positive psychological intervention on resilience and professional identity of "post-90s"nursing students during internship. Methods? A convenience sampling method was adopted. Nursing students of 2017 were selected as a control group (n=151) and nursing students of 2018 were selected as an intervention group (n=137). Nursing students in control group were given a conventional teaching method, while the psychological counseling team used staged group positive psychological interventions on nursing students in intervention group. Connor-Davidson Resilience Scale(CD-RISC) and Professional Identify Scale were used to evaluate the effect of intervention. Results? The CD-RISC score and Professional Identify Scale score of intervention group were (89.58±21.37)and (5.48±0.29), both higher than those of control group(t=2.253,5.725;P＜ 0.05). Conclusions? The staged group positive psychological intervention has positive effect on the psychological resilience and professional identity of the "post-90s" nursing students during internship, which provides a reference for further maintenance of the mental health of nursing students and stabilization of the nursing team.

BACKGROUND:Parkinson's disease has the main pathological changes in the midbrain,especially in the dense substantia nigra,leading to impaired motor and non-motor function in patients.At present,research is limited by cellular heterogeneity,and its pathogenesis still needs to be further elucidated.In recent years,single-cell RNA sequencing(scRNA-seq)has gradually been applied in neurodegenerative diseases,which is of great significance for understanding intercellular heterogeneity,disease development mechanisms,and treatment strategies. OBJECTIVE:To review the research progress of scRNA-seq technology applied to Parkinson's disease in recent years,providing a theoretical basis for the application of scRNA-seq in the treatment and diagnosis of Parkinson's disease. METHODS:The first author used a computer system to search for relevant literature in the CNKI,WanFang,PubMed,and Web of Science databases,with the Chinese search terms"single-cell RNA sequencing,Parkinson's disease,cell heterogeneity,cell subtypes,dopaminergic neurons,glial cells"and English search terms"single-cell RNA seq,Parkinson disease,heterogenicity,subtypes,dopaminergic neurons,glial cells."71 articles were ultimately included for review and analysis. RESULTS AND CONCLUSION:(1)scRNA-seq is a high-throughput experimental technique that utilizes RNA sequencing at the single-cell level to quantify gene expression profiles in specific cell populations,revealing cellular mysteries at the molecular level.Compared with traditional sequencing techniques,scRNA-seq technology is used to reveal the diversity of cell types and changes in specific gene expression in complex tissues under various physiological and pathological conditions through automatic clustering analysis of cell transcriptome.(2)By using scRNA-seq,the development process of dopaminergic neurons and the unique functional characteristics of various cell subtypes are elucidated,in order to better understand potential therapeutic molecular targets.(3)The use of scRNA-seq analysis has improved our understanding of the response of Parkinson's disease glial cells,enabling us to comprehensively map and characterize different cell type populations,identify specific glial cell subpopulations related to neurodegeneration,and draw valuable single cell maps as reference data for future research.(4)The application of scRNA-seq to detect embryonic mice and stem cells will help improve the in vitro differentiation protocol and quality control of cell therapy,as well as evaluate the overall cell quality and developmental stage of dopaminergic neurons derived from stem cells.

ObjectiveTo explore the molecular mechanism of Qidi Tangshen prescription （QDTS） in regulating podocyte pyroptosis in diabetes nephropathy （DN）. MethodThrough in vivo experiment， db/db mice were divided into the model group， QDTS group （3.34 g·kg^-1）， valsartan capsule group （10.29 mg·kg^-1）， with db/m mice serving as the normal control. Each group consisted of 8 mice， and they underwent continuous intervention for 8 weeks. After the last administration， mice were euthanized， and kidney pathological changes were observed. Additionally， the expression levels of pyroptosis-related indicators， including NOD-like receptor protein 3 （NLRP3）， Gasdermin D protein （GSDMD）， and interleukin-1β （IL-1β） protein， were examined. Through in vitro experiment， mouse podocytes were divided into the normal glucose group （5.5 mmol·L^-1 glucose）， high glucose group （35 mmol·L^-1 glucose）， DMSO group （35 mmol·L^-1 glucose+200 mg·L^-1 DMSO）， and QDTS group （35 mmol·L^-1 glucose+200 mg·L^-1 QDTS freeze-dried powder）. After 48 hours of intervention， the expression levels of NLRP3， GSDMD， and IL-1β proteins were measured in podocytes. A drug-ingredient-target-disease interaction network for QDTS in the treatment of DN was constructed by network pharmacology methods. The key signaling pathways regulating podocyte pyroptosis were analyzed， and validation was conducted through in vivo and in vitro experiments. ResultCompared with normal group， glomerular hyperplasia and glomerular basement membrane thickening were observed in model group， and some segments were accompanied by obvious podocellular process fusion. The protein expressions of NLRP3， GSDMD and IL-1β in mouse kidney were increased， the protein expressions of mitogen-activated protein kinase 14 （MAPK14）， V-Rel reticuloendotheliosis virus oncogene homology A （RELA） and Caspase-8 in mouse kidney were increased （P<0.05）. Compared with model group， kidney pathological injury of mice in QDTS group was significantly reduced， and the expressions of NLRP3， GSDMD and IL-1β in kidney of mice in QDTS group and valsartan group were decreased （P<0.05）. The protein expressions of MAPK14， RELA and Caspase-8 in kidney of mice in QDTS group and valsartan group were decreased （P<0.05）. Network pharmacology results showed that there were 16 targets for QDTS to regulate DN cell pyrodeath， among which MAPK14， RELA and Caspase-8 were the key targets. Compared with normal glucose group， the protein expressions of NLRP3， GSDMD and IL-1β in high glucose group were increased （P<0.05）， and the protein expressions of MAPK14， RELA and Caspase-8 in mouse podocytes were increased （P<0.05）. Compared with high glucose group， the expressions of NLRP3， GSDMD and IL-1β in podocytes of mice in QDTS group were decreased （P<0.05）， and the expressions of MAPK14， RELA and Caspase-8 in podocytes of mice in QDTS group were decreased （P<0.05）. ConclusionQDTS reduces damage to DN podocytes， which is associated with its regulation of the MAPK14/RELA/Caspase-8 signaling pathway and inhibition of podocyte pyroptosis.

ObjectiveTo explore the mechanism of Qidi Tangshen prescription （QDTS） in alleviating podocyte injury and reducing urinary protein in diabetic nephropathy （DN）. MethodUsing network pharmacology methods， we collected the chemical components and targets of QDTS， as well as the targets related to DN. Subsequently， we constructed a "drug-ingredient-target-disease" network for QDTS in the treatment of DN to systematically elucidate the mechanism. The db/db mice were assigned into the model， QDTS （3.34 g·kg^-1）， and losartan capsules （10.29 mg·kg^-1） groups， and db/m mice served as the normal group. Each group consisted of 8 mice， and they underwent continuous intervention for 8 weeks. After the last administration， mice were euthanized， and the urinary albumin excretion rate （UAER） and renal pathological changes were measured and observed. The expression levels of protein kinase B1 （Akt1）， hypoxia-inducible factor-1 alpha （HIF-1α）， phosphorylated B-cell lymphoma-extra-large （p-Bcl-xl）， as well as autophagy-related indicators microtubule-associated protein 1 light chain 3 （LC3）， ubiquitin-binding protein p62 （p62）， and autophagy-related gene 6 homolog （Beclin1）， were determined. Furthermore， mouse podocytes were divided into the normal glucose （5.5 mmol·L^-1）， high glucose （35 mmol·L^-1）， DMSO （35 mmol·L^-1 glucose+200 mg·L^-1 DMSO）， and QDTS （35 mmol·L^-1 glucose+200 mg·L^-1 QDTS freeze-dried powder） groups. After 48 h of intervention， the protein levels of Akt1， HIF-1α， p-Bcl-xl， LC3， p62， and Beclin1 in podocytes were measured. ResultQDTS had 34 active components acting on 143 targets in the treatment of DN， and 55 targets were related to autophagy， in which Akt1， HIF-1α， and Bcl-xl were the key targets. Compared with the normal group， mice in the model group exhibited significantly increased UAER， glomerular hypertrophy， deposition of blue collagen fibers， thickening of the glomerular basement membrane， and noticeable fusion of podocyte foot processes in some segments. Furthermore， the modeling up-regulated the protein levels of p-Akt1， HIF-1α， and p62 and down-regulating the protein levels of p-Bcl-xl， LC3， and Beclin1 in the renal tissue （P<0.05）. Compared with the model group， QDTS and losartan decreased UAER （P<0.05） and alleviated the pathological damage in the renal tissue. Moreover， QDTS and losartan down-regulated the protein levels of p-Akt1， HIF-1α， and p62 and up-regulated the protein levels of p-Bcl-xl， LC3， and Beclin1 in the renal tissue （P<0.05）. In comparison to the normal glucose group， the high glucose group displayed up-regulated protein levels of p-Akt1， HIF-1α， and p62 and down-regulated protein levels of p-Bcl-xl， LC3， and Beclin1 in podocytes （P<0.05）. Compared with the high glucose group， QDTS down-regulated the protein levels of p-Akt1， HIF-1α， and p62 and up-regulated the protein levels of p-Bcl-xl， LC3， and Beclin1 in podocytes （P<0.05）. ConclusionQDTS alleviates podocyte damage and reduced urinary protein in DN by regulating the Akt1/HIF-1α/Bcl-xl signaling pathway， thereby enhancing podocyte autophagy.