Objective To find out the cerebral blood flow velocity and its relationship with attention and execu?tion function in patients with major depressive episode. Methods A total of 70 patients with major depressive episode and 65 healthy controls were included. The 24 items Hamilton depression scale (HAMD-24) was adopted for patients' depressive symptoms assessment. The Cancellation Test (CT) and Wisconsin Card Sorting Test (WCST) were adopted for cognitive function assessment. And the blood flow velocity of cerebral arteries were detected by transcranial Doppler ul?trasonography (TCD). Results Compared with the controls, the patients showed significantly slower average blood flow ve?locity in basilar artery, left middle cerebral artery, right middle cerebral artery, left anterior cerebral artery and right ante?rior cerebral artery (P<0.05). Compared with those in the controls, the net score of each stage and the total net score of CT were significantly lower in the patients, while the total number of responses, response errors, perseverative errors and the necessary response number to complete the first category of WCST were significantly higher (P<0.01). The blood flow velocity in the cerebral basilar artery (r=0.25), left middle cerebral artery (r=0.46), right middle cerebral artery (r=0.25) and right posterior cerebral artery (r=0.26) showed positive correlations with total net score of CT (P<0.05), and the cere?bral artery average blood flow velocity showed negative correlations with the total number of responses, response errors and perseverative errors of WCST in the patients (P<0.05). Conclusions Compared with healthy controls, patients with major depressive episode suffer from lower average cerebral artery blood flow velocity, bad attention and executive func?tion. The change of average cerebral artery blood flow velocity may be responsible for impaired cognitive function in epi?sode major depression patients.

BACKGROUND: The Childhood Experience of Care and Abuse Questionnaire (CECA.Q) compiled by the Institute of Psychiatry, University of London, has been verified to have good reliability and validity in the assessment of foreign community adults and patients with affective disorder,but the application of CECA.Q in China still needs verification of reliability and validity in various population.OBJECTIVE: To analyze the reliability and validity of CECA.Q in community population.DESIGN: The subjects were randomized selected; the principle for the analysis of scale reliability and validity was followed.SETTING: Mental Health Institute of Central South University.PARTICIPANTS: From September 2003 to February 2004, 608 adults were selected from two communities of Hunan Changsha city and Henan Xinxiang city as the common community population group, totally 608scales of CECA.Q were sent out, 8 invalid ones were excluded, and finally 600 subjects finished the investigation. Sixty adult inpatients with depressive disease were randomly selected from Henan Provincial Psychiatric Hospital as the depression group.METHODS: The common community population and patients with depressive disease were investigated with CECA.Q, which was a self-rating scale mainly to retrospectively survey whether the adults had suffered from physical, sexual or mental abuse in their childhood, and the mental abuse had two factors of antipathy and neglect, and each included 8 items. The answers for the items were quantified into 5 grades. The subjects evaluated whether their parents had given any abuse to them; the higher the score was, the greater the mental abuse they suffered. Of the community population, 40 cases were the positive samples with the history of physical and sexual abuse in childhood evaluated by CECA.Q, and they were then assessed with Bifulco provided childhood experience of care and abuse (CECA) together with 40 cases randomly selected from 560 samples with negative evaluation. A total of 100 cases in the community population were also evaluated with Zung self-rating depression scale (SDS), besides, 30 cases were retested with CECA.Q at 2 weeks after the first evaluation.MAIN OUTCOME MEASURES: The internal consistency, test-retest reliability, contents and criterion validity of CECA.Q were analyzed. RESULTS: Of the community population, 8 invalid questionnaires were excluded, and the other 600 cases entered the statistical analysis. ① Testretest reliability of CECA.Q: The Cronbach α coefficient for the mental abuse section was 0.87 (0.85 for maternal one, 0.83 for paternal one); including that of antipathy factor was 0.84 (0.80 for maternal one, 0.81 for paternal one), and that of neglect factor was 0.85 (0.84 for maternal one,.83 for paternal one. The test-retest reliability coefficient for mental abuse as 0.83 (0.81 for maternal one, 082 for paternal one), including that of antipathy was 0.81 (0.82 for maternal one, 0.70 for paternal one), and that f neglect was 0.79 (0.78 for maternal one, 0.75 for paternal one). The twice evaluations of physical and sexual abuse had good consistency (Kappa=0.78). ② Criterion validity of CECA.Q: The correlation coefficients of mental abuse, antipathy and neglect factors in CECA.Q with Zung SDS were 0.58, 0.55 and 0.60 respectively (P＜0.01). CECA.Q and CECA had good consistency in evaluating history of physical and sexual abuse, and the score of mental abuse in the depressive patients was higher than that in community population (P＜0.05).CONCLUSION: The CECA.Q shows acceptable reliability and validity in community population, and can be used as a self-rating measure for childhood abuse experience in China.

Wake up ischemic stroke (WUIS),also known as awakening stroke,refers to patients with no new stroke symptoms during sleep,but after waking up,the patients or witness who found the acute cerebral infarction with stroke performance.The key to the treatment of acute ischernic stroke is to effectively restore reperfusion within the time window.The original intravenous recombinant tissue-type plasminogen activator (rt-PA) thrombolytic therapy,is widely recognized as an effective treatment method of choice for 4.5h onset of acute ischemic stroke reperfusion.Because the exact onset time of WUIS is unclear and limited by current scientific and technical levels,intravenous thrombolysis may lead to an increased risk of intracranial hemorrhage.Therefore,the American Heart Association and the American Stroke Association (AHA/ASA) were included in the "Intravenous Thrombolysis".Intravenous thrombolysis is not recommended in the Standard Scientific Statement.Patients who may be suitable for thrombolytic therapy are not able to obtain thrombolytic therapy,resulting in poor clinical prognosis.In recent years,with the further development of relevant clinical research and the rapid development of imaging technology,the latest research found that multi-mode imaging examination is safe and effective for intravenous thrombolytic therapy in patients with poststroke stroke.Multi-mode imaging studies help screening patients with acute reperfusion therapy,so that part of WUIS patients will benefit from the acute reperfusion therapy.This article reviews and summarizes the literature findings of WUIS in recent years.The pathophysiological changes,clinical features and imaging changes of patients with WUIS and non-WUIS are almost unanimously.Early CT and MRI examinations can help to extend acute stroke treatment to patients with WUIS.At present,for this type of patients,there are great research progress in the formulation and implementation of clinical treatment strategies.This article will briefly summarize the research progress and treatment status of WUIS.

Objective To investigate the predictive effect of hypersensitive C-reactive protein(Hs-CRP)and neutrophil and lymphocyte ratio(NLR)on the prognosis in young patients with ischemic stroke. Methods From October 2016 to October 2017,110 consecutive young patients(18-45 years old)with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. According to the modified Rankin scale(mRS)scores,they were divided into either a good prognosis group(mRS≤2;n=90)or a poor prognosis group(mRS>2;n=20).The patients completed the related examinations within 24 h after admission,including blood routine and Hs-CRP.The NLR value was calculated according to the count of neutrophils and lymphocyte in blood routine.The age,gender,underlying diseases(hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia),histories of smoking and drinking,National Institutes of Health stroke scale(NIHSS)scores of both groups of patients were documented.The poor prognosis after discharge at 90 d was used as the dependent variable,the independent variables of P<0.05 in univariate analysis were further performed with multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of the independent risk factors. The Youden index was calculated and the optimal cut-off value was determined. Results (1)Compared with the good prognosis group,the poor prognosis group had higher NIHSS score,NLR and Hs-CRP at admission.The differences between the 2 groups were statistically significant(9.0[4.5,13.0]vs.2.5[2.0,4.0],2.97[2.31,4.20]vs.2.13[1.76,2.70],4.65 [2.70,9.52]mg/L vs.2.06[0.87,4.54]mg/L;all P<0.05).There were no significant differences in other baseline data and clinical characteristics between the two groups(all P>0.05).(2)The results of the multivariate logistic regression analysis indicated that the high level of Hs-CRP(OR,1.086,95%CI 1.009-1.169)and higher NIHSS score(OR,1.487,95%CI 1.229-1.797)at admission were the independent risk factors for poor prognosis(all P < 0. 05),and there was no significant relation between NLR and prognosis(P>0.05).(3)The area under the ROC curve of the Hs-CRP levels at admission was 0.722(95%CI 0.591-0.853,P=0.002).When the predictive value of Hs-CRP level at admission was 3.365 mg/L,the maximum Youden index was 0.367,its corresponding sensitivity was 70.0%and specificity was 66.7%. Conclusions The higher Hs-CRP level and NIHSS score at admission may independently predict the poor prognosis of young patients with ischemic stroke at 90 d after discharge to a certain extent.It is not appropriate to use Hs-CRP≥3.365 mg/L alone for poor prognosis screening,but NLR may not be associated with the prognosis at admission.

Objective To investigate the clinical characteristics and mechanism of cavernous sinus dural arteriovenous fistula (CSDAVF). Methods The clinical data of 17 CSDAVF patients, including clinical manifestations, characteristics of cerebrospinal fluid (CSF)and neuroimaging,were analyzed.The interventional catheter embolization of CSDAVF and postoperative follow-up were performed. Results Of the 17 subjects with CSDAVF, 5 (29.4%) were men and 12 (70.6%)were women (sex ratio=1:2.4).The average age of onset was (58.12±14.61)years old. Older CSDAVF patients were prone to be complicated with hypertension than general population at the same age. Onset symptoms included headache in 6 cases,eye symptoms in 5 cases,intracranial murmur in 2 cases,diplopia in 2 cases, dizziness in 1 case and slurred speech in 1 case. Digital subtraction angiography (DSA) was performed in all 17 patients. Further embolization was applied in 14 patients and had satisfactory outcome. In CSDAVF patients with headache, 2 patients showed orthostatic headache as initial symptom. One of them with intracranial hypotension reported exophthalmos 3 months after the onset. Those two patients remained asymptomatic during 3-year and 2-year follow-up after receiving interventional catheter embolization for CSDAVF. Conclusions CSDAVF usually occurs in middle-aged and older women, especially in those with hypertension. CSDAVF varies in clinical manifestations. A special attention should be given to orthostatic headache which can be presented as the initial symptom in few patients with CSDAVF. CTA or DSA should be considered in patients with clinically suspected CSDAVF to rule out the possibility of CSDAVF. The interventional catheter embolization is the primary treatment of CSDAVF.

Objective:To observe the clinical effect of hernia ring filling tension-free hernia repair on adult inguinal hernia.Methods:From March 2016 to March 2019, 100 adult patients with inguinal hernia who received surgical treatment in Zhoushan Maternal and Child Health Hospital were divided into two groups according to the random number table method, with 50 cases in each group.The control group received the chip without tension hernia repair, and the study group received hernia ring filling type without tension hernia repair.The operation time, length of hospital stay, use of analgesic ratio, ratio of postoperative patients with local foreign body sensation, incidence of adverse reactions (incision infection rate, rate of seroma, scrotal edema rate) were compared between the two groups.Results:The operation time [(0.86±0.22)h] and hospital stay [(5.11±1.56)d] in the study group were shorter than those in the control group [(1.44±0.76)h and (9.87±1.33)d] ( t=5.183, 16.418, all P<0.05). And the ratio of use analgesics (20.00%), the ratio of local foreign body sensation (2.00%), the incidence of adverse reactions (incision infection rate: 2.00%, seroma rate: 4.00%, scrotal edema rate: 2.00%) and other indicators in the study group were lower than those in the control group (36.00%, 18.00%, 8.00%, 10.00%, 8.00%)(χ 2=5.183, 16.418, 3.174, 7.111, 5.740, all P<0.05). Conclusion:Application of the hernia ring filling tension-free hernia repair in the treatment of adult inguinal hernia can shorten the operation time, hospital stay and decrease the incidence rate of adverse reactions.

Objective To investigate the therapeutic effect of damage control neurosurgery (DCNS) on patients with bilateral frontal contusion.Methods Thirty-three patients with bilateral frontal contusion,admitted to and accepted DCNS in our hospital from September 2017 to January 2019,were chosen in our study.According to DCNS rules,the disease condition changes of these patients were monitored,the internal environment disorders after trauma were adjusted,plasma osmotic pressure was increased,and blood oxygen saturation was maintained;once the patients grew worse,craniotomy and decompression should be undertaken immediately;the patients were followed up for 6 months after the injury and Glasgow outcome scale (GOS) was used to determine the prognoses of these patients.Results Among the 33 patients,25 (76％) received conservative treatment successfully,8 (24％) were converted to surgery during conservative treatment.Among the 8 patients,5 received unilateral craniotomy and three received bilateral craniotomy.The lower the Glasgow coma scale scores,the lower the proportion of conservative patients.GOS 6 months after injury showed good recovery in 11 patients,mild disability in 16 patients,severe disability in 4 patients,and plant survival in two patients;22 patients from the conservative treatment group and 5 from the surgery group had good recovery or mild disability.Conclusion DCNS can reduce the operation rate and its complications so as to make the patients recover earlier and better in the treatment of bilateral frontal contusion.

Drug adulteration and contamination are serious threats to human health therefore,their accurate monitoring is very important.Allopurinol(Alp)and theophylline(Thp)are commonly used drugs for the treatment of gout and bronchitis,while their isomers hypoxanthine(Hyt)and theobromine(Thm)have no effect and affect the efficacy of the drug.In this work,the drug isomers of Alp/Hyt and Thp/Thm are simply mixed with α-,β-,y-cyclodextrin(CD)and metal ions and separated using trapped ion mobility spectrometry-mass spectrometry(TIMS-MS).TIMS-MS results showed that Alp/Hyt and Thp/Thm iso-mers could interact with CD and metal ions and form corresponding binary or ternary complexes to achieve their TIMS separation.Different metal ions and CDs showed different separation effect for the isomers,among which Alp and Hyt could be successfully distinguished from the complexes of[Alp/Hyt+y-CD+Cu-H]+with separation resolution(Rp-p)of 1.51;whereas Thp and Thm could be baseline separated by[Thp/Thm+y-CD+Ca-H]+with Rp-p of 1.96.Besides,chemical calculations revealed that the complexes were in the inclusion forms,and microscopic interactions were somewhat different,making their mobility separation.Moreover,relative and absolute quantification was investigated with an internal standard to determine the precise isomers content,and good linearity(R2＞0.99)was ob-tained.Finally,the method was applied for the adulteration detection where different drugs and urine were analyzed.In addition,due to the advantages of fast speed,simple operation,high sensitivity,and no chromatographic separation required,the proposed method provides an effective strategy for the drug adulteration detection of isomers.

Objective:The present study was designed to strengthen the education of research integrity, and to improve the awareness of academic misconduct and academic literacy of medical post-graduate students.Methods:A questionnaire survey was conducted with master post-graduate students of a university affiliated hospital, and statistical analysis on the education of research integrity and the perception of academic misconduct among the survey respondents was performed.Results:Academic master post-graduate students′ cognitions of the misconduct in scientific research process and overall academic misconduct were better than that of professional master post-graduate students, and there were significant differences ( P<0.05). The more times of participation in research integrity training, the better cognition of misconduct of scientific research process, research results publication process, and overall academic misconduct, with significant differences ( P<0.05). Conclusions:The education on scientific research integrity of medical post-graduates should be carried out systematically, while the content should be improved and the form should be enriched for scientific research integrity education, so that the medical post-graduates can have a deeper understanding of the code of academic practices, and an education model of scientific research integrity for medical post-graduate which is suitable for China′s national conditions can be gradually developed.

Objective To observe the value of FOLFOX-hepatic arterial infusion chemotherapy(HAIC)combined with programmed cell death receptor-1(PD-1)inhibitor+targeted drug for treating China liver cancer staging(CNLC)stageⅢa hepatocellular carcinoma(HCC).Methods Sixty-one patients with CNLC stage Ⅲa HCC who underwent PD-1 inhibitor+targeted drug treatment were retrospectively enrolled and divided into observation group(n=30)and control group(n=31)based on whether received FOLFOX-HAIC treatment or not.The general information,treatment strategy,adverse reactions and therapeutic effects were compared between groups,and the value of treatment strategy in observation group was analyzed.Results No significant difference of general information nor PD-1 inhibitor+targeted drug strategy was found between groups(both P＞0.05).Among 1-2 grade adverse reactions,the incidence of nausea,vomiting and abdominal pain in observation group were higher than those in control group(both P＜0.05),while no significant difference of the other 1-2 grade nor 3 grade adverse reactions was observed(all P＞0.05).The objective response rate(ORR),progression free survival(PFS)and overall survival(OS)of observation group were all higher than those of control group(all P＜0.05).Conclusion FOLFOX-HAIC combined with PD-1 inhibitor+targeted drug was more effective for treating CNLC stage Ⅲa HCC with acceptable safety.