Objective To investigate the prevalence,characteristics and risk factors of fatigue in a large cohort of subjects with early Parkinson's disease (PD).Methods A total of 391 individuals with PD,recruited in Linzhi trial,were re-screened.Early,non-depressed subjects [Center for epidcmiological survey depression scale (CES-D)＜16]underwent further fatigue assessment.Subjects who scored＞4 on fatigue severity scale (FSS) were classified as fatigue.Motor symptoms and PD severity were assessed using the unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr scale.Other clinical measures,including sleep disorder by Pittsburg sleep quality index (PSQ-Ⅰ),mental function by Alzheimer's Disease assessment scale-cognitive sections (ADAS-Cog) and quality of life by medical outcomes study short form 36 (SF- 36) were also evaluated.Results Among 204 subjects who completed fatigue measures,82 (40.2％) were classified as fatigue.The fatigue group had significantly more neurological impairment by higher scores on each subsets of UPDRS including mentation (P＜0.05),activities of daily living (P＜0.01) and motor (P＜0.01),while the subjects with fatigue had worse scores on SF-36 (P＜0.01).Multiple regression analyses showed that motor subset of UPDRS was the variable that had the predictive value for FSS score.The full model explained 6.4％ of the variance of the FSSscore (β=0.039,95％CI:0.019-0.059).However,other factors,including levodopa dosage,PSQ-Ⅰ,and ADAS-Cog score did not significantly contribute to the model.Conclusions Fatigue is a frequent symptom in carly,non-depressed patients with PD,affecting over 40％ of the patients in this cohort.The small correlation between fatigue and motor score,and the lack of association with dosage of dopaminergic treatment suggest that dopaminergic pathways might be only moderately involved in pathogenesis of fatigue.

Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.

Objective To investigate the effects of early hemofiltration combined with traditional Chinese medicine on nasal feeding on severe acute pancreatitis (SAP) patients. Methods Seventy four patients were divided into traditional Chinese medicine group (group A, 35 cases) and traditional Chinese medicine+hemofiltration group (group B, 39 cases). In group A, patients were given a serious of procedure including fasting, gastrointestinal decompression, fluid resuscitation, inhi-bition of pancreatic secretion, antibiotic prophylaxis, parenteral nutrition and traditional Chinese medicine on nasal feeding;In group B, patients received continuous veno-venous hemofiltration treatment(also called Continuous Renal Replacement Therapy,CRRT) in addition to the procedures receiving by group A. On admission and the first, 3rd, 7th days post-treatment, the scores of acute physiology and chronic health evaluation (APACHEⅡ), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) levels were recorded. Length of hospital stay, local and systematic complications, surgical inter-vention, mortality and hospitalization expenses were compared between two groups. Results On admission, no statistical significance was seen in the hematocrit, white blood cell count, lactic acid dehydrogenase, blood urea nitrogen, blood glu-cose, APACHEⅡscore, Ranson’s score and classification of etiology between these two groups (P>0.05). But APACHEⅡ, TNF-α, IL-6, IL-8 were decreased significantly in group B than in group A, after the first, 3rd, 7th days post-treatment (P＜0.05). Compared with group A, the length of hospital stay, local complications, systemic complications, surgical interven-tion, mortality and hospitalization expense were lower in group B. Conclusion Traditional Chinese medicine on nasal feed-ing combined with early hemofiltration could effectively reduce complications, incidence of organ dysfunction and could im-prove the prognosis of SAP patients.

Objective To explore the relationship between osteoporosis and serum total type Ⅰ amino terminal extension of the peptide,vitamin D3 and smoking index in the patients with chronic obstructive pulmonary disease (COPD).Methods One hundred and fifty patients with COPD (test group) and 150 healthy people (control group) were selected.The total type Ⅰ amino terminal extension of the peptide was measured by electrochemical luminescence,and enzyme-linked immunoassay was adopted to determine the vitamin D3.The 150 patients with COPD were divided into slight group (45 cases),moderate group (52 cases) and severe group (53 cases) according to the severity of COPD.In 150 patients with COPD,120 patients with smoking were divided into 3 groups according to smoking index:A group smoking index ＜ 360,36 cases;B group smoking index 360-400,34 cases;and C group smoking index 401-560,50 cases.The levels of serum total type Ⅰ amino terminal extension of the peptide and vitamin D3 were compared and correlation was analyzed.Results The vitamin D3 and the total type Ⅰ amino terminal extension of the peptide levels in test group were significandy lower than those in control group:(35.37 ± 12.11) mg/L vs.(45.88 ± 12.55) mg/L and (38.16 ± 11.12) mg/L vs.(45.23 ± 12.33) mg/L,and there were statistical differences (t =2.74 and 4.64,P＜ 0.01).The levels of vitamin D3 and the total type Ⅰ amino terminal extension of the peptide in slight,moderate and severe group were decreased in turn,and the levels of total type Ⅰ amino terminal extension of the peptide and the vitamin D3 were positively associated with the severity of COPD (r =0.185 and 0.257,P ＜ 0.05).The levels of vitamin D3 and total type Ⅰ amino terminal extension of the peptide in A,B and C group were decreased in turn,and the levels of total type Ⅰ amino terminal extension of the peptide and the vitamin D3 were positively associated with smoking index (r =0.159 and 0.172,P ＜ 0.05).Conclusion COPD patients are easier to suffer from osteoporosis compared with healthy population,and the serum vitamin D3 and total type Ⅰ amino terminal extension of the peptide can forecast the osteoporosis in COPD patients.

Objective The study was to evaluate the behavioral differences in learning and memory abilities among three ani -mal models of Alzheimer′s disease. Methods Three SD rat models(n=20) were used in this study.The first SD rat model was es-tablished by intracerebral injection of Aβ25-35 into the bilateral hippocampus , the second mouse model was induced by intraperitoneal in-jection of scopolamine and the third was a senescence accelerated mouse model .Morris Water maze test was performed to investigate behavioral differences by comparison to corresponding blank control groups ( sham operation group , blank group and P8 group ) . Results The learning and memory abilities of senescence accelerated rats and scopolamine -treated rats were worse than those of the corresponding control groups, especially the scopolamine-treated rat ([35.47 ±3.78]s vs [50.61 ±3.94]s, P<0.01).There was no significant difference between Aβrats and sham-operated rats(P>0.05). Conclusion The model of Alzheimer′s disease in-duced by intraperitoneal injection of scopolamine represents more distinct changes in learning and memory abilities .Morris water maze test can be used to well evaluate whether the scopolamine-induced model is successfully established or not .

Previous studies suggest that NGAL (neutro phil gelatinase-associated lipocalin) is involved in the transformation and development of esophageal carcinoma. Alteration of NGAL expression can trigger the change of cellular morphology in esophageal carcinoma cells. However, the mechanisms remain unclear. To get a better understanding of NGAL function in esophageal carcinoma, NGAL protein was expressed in methylotrophic yeast, Pichia pastoris, and purified by chromatography. EC1.71 cells expressed high levels of NGALR (NGAL receptor) and EC109 cells expressed low levels of NGALR were used as cells model. The trafficking and the possible function of NGAL protein were then analyzed in the esophageal carcinoma cells. The results showed that 5-FAM-labeled recombinant NGAL protein could internalize into the EC1.71 and EC109 cells. Furthermore, the internalized NGAL protein could induce the alteration of cellular morphology, resulting in generation of autophagosome, transcriptional up-regulation of genes associated with autophagy and increase of phospho-ERK1/2 (p-ERK1/2). Interestingly, the treatment with the NGAL protein did not affect the intracellular iron level. These data indicate that induced autophagy by exogenous NGAL protein is a mechanism that internalized NGAL plays important roles in esophageal carcinoma cells, independent with NGAL-mediated iron transport process, while ERK1/2 signal pathway is involved in activation of autophagy by exogenous NGAL protein.

Objective: To explore the cumulative effects of unintentional injury among children in rural area, in order to provide information for early intervention of unintentional injury. Methods: Through multistage clustering sampling method, 2 109 primary caregivers of students from 8 rural primary and elementary schools of Heilongjiang Province were recruited. Strengths and Difficulties Questionnaire (SDQ), Injury Behavior Checklist (IBC), Perceptions of Risks and Hazards were used to collect as the risk factors, while Perceptions of Risks and Hazards (PSAPQ), Home Observation for Measurement of the Environment (HOME) and Knowledge, Attitude and Practice for Children Unintentional Injury (KAP) were also used as the protective factors. Risk factors index (RFI) and protective factors index (PFI) were computed in the study. Results: The severity of unintentional injury were positively correlated with SDQ, IBC and perceptions of risks and hazards(r=0.15, 0.23, 0.12, P<0.01), and were negatively correlated with HOME, PSAPQ and KAP(r=-0.25, -0.14, -0.09, P<0.01). Hierarchical linear regression showed that the total scores of SDQ, IBC and environmental of HOME predicted the severity of unintentional injury which could explain 34% variant of unintentional injury. It also indicated that the severity of unintentional injury were positively correlated with RFI (β=0.21) and negatively correlated with PFI(β=-0.18), the interaction was significant(β=-0.11,R2=0.31)(P<0.01). Conclusion Both risk and protective factors of unintentional injury have cumulative effects on the severity of injury among rural children. The relationship between risk factors and injury could be mediated by protective factors.

Objective To explore the protective effect of polypeptide Apelin on podocyte mitochondria in diabetic nephropathy and underling mechanisms.Methods Human renal podocytes were divided into four experimental groups:control group,high glucose(HG)group(glucose 25 mmol/L,48 h),Apelin intervention HG group(Ape-lin-13 1 μmol/L,48 h)and Apelin group(Apelin-13 1 μmol/L,48 h).The podocyte apoptosis was observed by TUNEL staining,the expression of mitochondrial membrane protein FUNDC1 was detected by Western blot,and the binding of mitochondrial fission protein DRP1 to FUNDC1 was examined by immunoprecipitation.The 8-week-old male mice were divided into three experimental groups:control group,diabetes group(intraperito-neal injection of streptozotocin 150 mg/kg,only one time)and Apelin intervention DM group(intraperitoneal injection of Apelin-13 0.3 μmol/kg,daily).The morphology of renal was observed by PAS staining and trans-mission electron microscopy.Plasma creatinine(Cr),urea nitrogen,urinary albumin and creatinine were de-tected by ELISA kit.The level of creatinine clearance rate(Ccr)and urinary albumin/creatinine(ACR)was calculated.Results Compared with the control group,the podocyte apoptosis and expression of FUNDC1 in the HG group increased significantly(P＜0.05),and the combination of mitochondrial fission division protein DRP1 to FUNDC1 raised.Meanwhile,compared with the HG group,the number of apoptosis,the expression of FUNDC1(P＜0.05),and the combination of DRP1 to FUNDC1 all reduced in Apelin intervention HG group.Animal experiments showed that the kidney structure of the control group was intact.In the DM group,the num-ber of podocytes decreased significantly,the foot processes were fused and dropped off.In the Apelin intervention DM group,podocyte lesions were less severe than those in the DM group.Compared with the control group,the level of plasma Cr,BUN and urine ACR in the DM group increased,while the level of Ccr decreased significantly(P＜0.05).However,compared with the DM group,the level of above biomarkers in the Apelin intervention DM group was improved(P＜0.05).Conclusions Apelin keeps mitochondrial homeostasis and reduces podocyte ap-optosis by inhibiting the expression of mitochondrial membrane protein FUNDC1,which may contribute to allevia-tion of diabetic nephropathy.

Objective:To explore the application effect of evidence-based clinical practice of enhanced recovery after surgery multiple discrepancies theory (ERAS-MDT) in perioperative nursing of patients with hepatectomy.Methods:From January to December 2018, 62 patients with hepatectomy who received perioperative care of ERAS-MDT in the Department of Hepatobiliary and Pancreatic Surgery of Ningbo First Hospital of Zhejiang Province were selected as the control group. We reviewed the implementation effect, searched the clinical practice guidelines, systematic reviews and evidence summary related to ERAS-MDT, carried out field investigation and expert consultation, summarized the obstacle factors, formulated countermeasures, and built a standardized operation mode of ERAS-MDT. From January to December 2019, a total of 66 patients with hepatectomy who received standardized ERAS-MDT perioperative nursing were selected as the observation group. The first exhaust time, defecation time, first ambulation time, first oral feeding time, hospitalization time, nutritional status and pain score were compared between the two groups.Results:The first exhaust time, defecation time, first ambulation time, first oral feeding time, hospitalization time of the observation group were earlier than those of the control group, and the differences were statistically significant ( P<0.05) . The albumin level of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . The pain scores of the observation group on the operation day was lower than those of the control group, and the difference between the two groups was statistically significant ( P<0.05) . Conclusions:A standardized management model of ERSA-MDT based on evidence-based clinical practice exhibits positive effect on the perioperative recovery of hepatectomy patients, which can further improve the clinical outcome of patients.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.