Objective To explore the change of plasma D-dimer (DD),lactate dehydrogenase isoenzyme 3 (LDH3),tissue plasminogen activator (t-PA) in the early stage of acute pulmonary embolism and their clinical significance.Methods Forty-six patients with acute pulmonary embolism of early stage (pulmonary embolism group) and 50 cases of normal person (control group) were enrolled in this study.The patients in pulmonary embolism group were divided into low-risk(18 patients),middle-risk(15 patients) and higher-risk (13 patients).The levels of DD,LDH3 and t-PA were detected and compared.Results The levels of DD,LDH3 and t-PA in pulmonary embolism group were (2.95 ± 0.73) mg/L,(421.42 ± 63.29)U/L and (0.85 ±0.02) U/L,and significantly higher than those in control group [(0.03 ±0.01) mg/L,(198.17 ± 23.37) U/L and (0.59 ± 0.02) U/L] (P ＜ 0.05).The levels of DD,LDH3 and t-PA in low-risk patients [(1.49 ± 0.04) mg/L,(315.47 ± 38.24) U/L and (0.63 ± 0.01) U/L] were significantly lower than those in middle-risk patients [(2.22 ±0.27) mg/L,(382.41 ±54.36) U/L and (0.79 ±0.02) U/L] and higher-risk patients [(3.38 ± 0.98) mg/L,(583.93 ± 117.21) U/L and (0.92 ± 0.03) U/L] (P ＜ 0.05).The levels of LDH3 and t-PA in middle-risk patients were significantly lower than those in higher-risk patients (P ＜ 0.05).After treatment,the levels of DD,LDH3 and t-PA were significantly decreased [(2.95 ± 0.73)mg/L vs.(1.03 ±0.11) mg/L,(421.42 ±63.29) U/L vs.(223.24 ±25.04) U/L,(0.85 ±0.02) U/L vs.(0.62 ± 0.02) U/L] (P ＜ 0.05).Conclusions The levels of DD,LDH3 and t-PA in the early stage of acute pulmonary embolism are increased significantly,and with the remission of the patient's condition,the levels of DD,LDH3 and t-PA are decreased.United detection conduces to the diagnosis of acute pulmonary embolism.

Objective: To analyze the correlation between the psychological flexibility of newly recruited nurses and the change leadership behavior of head nurses, so as to guide nursing managers to strengthen management and improve the quality of nursing care of new nursing staff. Methods: From May 2017 to April 2018, 80 new nursing staff were surveyed using the psychological resilience scale and the change leadership style, and their correlation was analyzed. Results: According to the statistics, the total score of psychological reinforcement of new nursing staff was (2.74±0.52)points, the overall level was not high, and the head nurses' change leadership behavior and various dimension scores were positively correlated with the nursing staff's psychological elasticity score (r=0.240, P<0.05). Conclusion Nursing managers should give full play to the role of the head nurses' transformational leadership behavior, so as to act on the psychological flexibility of nursing staff and improve the overall level of care.

OBJECTIVE:To investigate the effects and safety of gamma globulin combined with phototherapy on serum preal-bumin(PAB)and total bile acid(TBA)of ABO hemolytic children. METHODS:A total of 90 ABO hemolytic children in our hos-pital during Feb. 2014-Sept. 2016 were selected as research objects and divided into observation group and control group according to random number table,with 45 cases in each group. Both groups were given routine active correction of hypoxia and pretreatment for possible hypoglycemia and hypothermia. Control group was additionally given phototherapy with wavelength of 425-475 nm. Ob-servation group was additionally given Human immunoglobulin for intravenous injection (pH4) 1.0g/kg was added to normal saline 10 mL,ivgtt,on the basis of control group and treated for 1 d. The time of jaundice regression,phototherapy duration and hospital-ization time were compared between 2 groups,and the levels of PAB and TBA were compared before and after treatment. The occur-rence of ADR was recorded in 2 groups. RESULTS:The time of jaundice regression,phototherapy duration and hospitalization time in observation group were significantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in the levels of PAB or TBA between 2 groups(P>0.05). After treatment,the level of PAB was increased significantly in 2 groups,while the level of TBA was decreased significantly;the observation group was significantly better than the control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Gamma globulin combined with phototherapy can significantly shorten the time of clinical symptom im-provement,increase serum level of PAB whlie decrease serum level of TBA in ABO hemolytic children,with good safety.

ObjectiveTo investigate the mechanism of Zexie Decoction （泽泻汤） in inhibiting neuroinflammation and improving cognitive impairment mediated by high-calorie diet. MethodsTwenty seven C57BL/J mice were randomly divided into control group （n = 9）， model group （n = 9） and Zexie Decoction group （n = 9）. The mice in the model group and the Zexie Decoction group were fed with high-calorie diet to establish the model of cognitive impairment. Meanwhile， the mice in Zexie Decoction group were also fed with 0.36 g/（kg·d）Zexie Decoction， and the mice in the control group and model group were fed with the same volume of normal saline for 8 weeks. The body weight of mice was recorded at the same time every week； after intervention， oral glucose tolerance test （OGTT） and insulin tolerance test（ITT） commenced； the cognitive level of mice was detected by Morris water maze， open field test， new object recognition test and Y maze； magnetic resonance spectroscopy （MRS） was used to detect the expression of N-acetylaspartate （NAA）， choline （CHO）， lactic acid （Lac）， creatine （Cr）， lipid （Lip）， and myoInositol （mI） in left hippocampus， hypothalamus and cortex. Western blotting was used to detect the expression of synaptophysin （SYN）， synaptosome associated protein-25 （SNAP-25）， postsynaptic dense protein-95 （PSD-95）， tumor necrosis factor-α （TNF-α）， nuclear factor kappa B （NF-κB p65） and its phosphorylated form （P-NF-B p65） in mouse brain； Nissl's staining was used to detect the morphological changes of hippocampal neurons. ResultsCompared with the control group， body mass， blood glucose in oral glucose tolerance test， and blood glucose in insulin tolerance test increased in the model group； in the Morris water maze experiment， the total distance travelled and escape latency of the model group mice increased， the time spent in the platform area and the number of times traversing the platform decreased on days 3 and 4； in the open-field experiment， the number of times the model group mice entered the central area， the ratio of the time in the central area to the total time， and the ratio of the distance travelled in the central area to the total distance significantly decreased； in the new object recognition test， the frequency of new object recognition and recognition index were significantly lower in the model group mice； in the Y-maze test， the spontaneous alternation rate of mice in the model group was significantly lower （P＜0.05 or P＜0.01）； in the left hippocampus， hypothalamus， and cortex of mice in the model group， the CHO/Cr， NAA/Cr significantly decreased， and the mI/Cr， Lac/Cr and Lip/Cr significantly increased； SYN/β-actin， SNAP-25/β-actin and PSD-95/β-actin values significantly decreased， and p-NF-κB p65/NF-κB p65 and TNF-α/β-actin values significantly increased in brain tissue （P＜0.05 or P＜0.01）. Compared with the model group， the above indexes of mice in the Zexie Decoction group significantly improved （P＜0.05 or P＜0.01）. The results of Nissl staining showed that compared with the control group， the neurons in the dentate gyrus of the hippocampus in the model group were scattered and sparsely arranged， the density was significantly reduced， the nuclei of the cells had consolidation and shrinkage， the number of Nissl vesicles was reduced， and the staining became lighter； compared with the model group， the density of neurons in the hippocampal dentate gyrus region of the Zexie Decoction group increased， the wrinkling of nuclei improved， the cell gap narrowed， and the arrangement was slightly tight. Concusion The ameliorative effect of Zexie Decoction on cognitive function in mice with high-calorie diet-induced cognitive impairment may relate to the restructuring of glucose metabolism homeostasis， inhibition of neuroinflammation， reduction of neuronal damage， and enhancement of synaptic plasticity.