Objective To investigate the effect of heroin abuse on attention switching. Methods Thirty-six Heroin abusers (33 males, 3 females) and 36 controls (32 males, 4 females) were enrolled in the study. Their cognitive function was tested by using the Switching Task, including Sustained Attention trials and Switching Attention trials. The reaction time and accuracy were recorded separately by the computer. Results The accuracy or reaction times were not signifi-cantly different between Switching Attention trial and Sustained Attention trial in heroin abusers, suggesting a lower Switch Costs value compared to the healthy controls [(19.7 ± 66.8) ms vs. (85.1 ± 92.4) ms]. The healthy controls showed faster reaction speed [Sustained Attention trial (695.3 ± 95.9) ms vs. Switching Attention trial (780.3 ± 93.3) ms, P<0.05] and higher accuracy [Sustained Attention trial (98.0%±2.2%) vs. Switching Attention trial (93.8%±5.0%), P<0.05] under the Sustained Attention trial. Compared with the healthy controls, the heroin abusers showed slower reaction speed [(791.6 ± 74.3) ms vs. (695.3±95.9) ms, P<0.05] and lower accuracy [(92.5%±8.4%) vs. (98.0%±2.2%), P<0.05] in Sus-tained Attention trial, but not in Switching Attention trial. Conclusions The present study has revealed absence of Switch Costs in heroin abusers, which may be related to the damage of heroin abusers in their Sustained Attention function.

Neurofibromatosis 1 (NF1) is an autosomal dominant genetic disease first manifesting in childhood, which affects multiple organs, childhood development and neurocognitive status. These patients have a high predisposition to develop both benign and malignant tumors. On September 30, 2018, a rare case of NF1 with B-lineage acute lymphocytic leukemia (ALL) was treated in the Department of Pediatrics, Third Xiangya Hospital, Central South University. The child presented with café au lait macules (CALM) since the date of birth. And the diagnosis of B-lineage ALL was made by bone marrow cytomorphologic examination and immunological phenotype detection. ETV6/RUNX1 fusion gene was positive. Also, a de novo mutation of c. 2773delT (p. Leu925Ter) was found in the exon of NF1 gene by gene sequencing, which was a nonsense mutation and led to the premature termination of peptide synthesis. Molecular genetic testing is recommended to confirm NF1, particularly in children with only pigmentary features of the diagnostic criteria. NF1-affected individuals should be referred to a specialist of NF1 clinical network for long-term follow-up and surveillance.

Qi-Yu-San-Long decoction(QYSLD)is a traditional Chinese medicine that has been clinically used in the treatment of non-small-cell lung cancer(NSCLC)for more than 20 years.However,to date,metabolic-related studies on QYSLD have not been performed.In this study,a post-targeted screening strategy based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight full infor-mation tandem mass spectrometry(UPLC-QTOF-MSE)was developed to identify QYSLD-related xeno-biotics in rat urine.The chemical compound database of QYSLD constituents was established from previous research,and metabolites related to these compounds were predicted in combination with their possible metabolic pathways.The metabolites were identified by extracted ion chromatograms using predicted m/z values as well as retention time,excimer ions,and fragmentation behavior.Overall,85 QYSLD-related xenobiotics(20 prototype compounds and 65 metabolites)were characterized from rat urine.The main metabolic reactions and elimination features of QYSLD included oxidation,reduction,decarboxylation,hydrolysis,demethylation,glucuronidation,sulfation,methylation,deglycosylation,acetylation,and associated combination reactions.Of the identified molecules,14 prototype compounds and 58 metabolites were slowly eliminated,thus accumulating in vivo over an extended period,while five prototypes and two metabolites were present in vivo for a short duration.Furthermore,one pro-totype and five metabolites underwent the process of"appearing-disappearing-reappearing"in vivo.Overall,the metabolic profile and characteristics of QYSLD in rat urine were determined,which is useful in elucidating the active components of the decoction in vivo,thus providing the basis for studying its mechanism of action.

The use of mechanical ventilation is more common in the diagnosis and treatment of clinical critically ill patients. However, in the process of mechanical ventilation, it may be difficult to withdraw from the machine due to various factors other than the primary disease. Among them, intra-abdominal hypertension, accumulation of analgesic and sedative drugs, and weakness of diaphragmatic function are common causes of difficulty in weaning. Acupuncture has obvious efficacy in regulating gastrointestinal function, exerting analgesic and sedative effect and improving muscle weakness. Acupuncture intervention can optimize the scheme of mechanical ventilation weaning, and improve the success rate by correcting different concurrent factors.

Objective:To evaluate the application effect of the "group-based" teaching assistant (TA) guidance model in homogenized clinical skill training.Methods:A pilot study was conducted on the cardiopulmonary resuscitation training course, and 32 students majoring in clinical integrative Chinese and Western medicine (five-year program) who were admitted to Shanghai University of Traditional Chinese Medicine in 2018 were randomly divided into control group ( n = 16) and TA group ( n = 16). The control group received traditional teaching methods, and the TA group was further divided into subgroups A, B, C, and D, with four graduate TAs providing group-based teaching. The groups were compared in terms of their satisfaction and test scores. SPSS 25.0 was used for t-test and analysis of variance. Results:The satisfaction survey showed that compared with the control group, the TA group had significantly higher degree of satisfaction with the increased practical opportunities, clinical skill practical ability, learning effect, and overall satisfaction. The immediate test showed that there was no significant difference in test score between the TA group (85.19±2.93) points and the control group (82.75±4.52) points. The test 30 days later showed that the TA group (83.50±5.13) points had a significantly higher test score than the control group (74.68±3.87) points, and the control group had a significantly lower test score than that in the immediate test ( P <0.001); however, there was no significant difference in the TA group's score between the immediate test and the test 30 days later. Conclusion:The "group-based" TA guidance model has a good effect in homogenized clinical skill training, and has a stable long-term effect, with high student satisfaction.

Objective To establish the biomechanical model of skeletal muscle during hand grasping for reverse dynamics simulation, so as to obtain the maximum muscle force of each muscle involved in the process of hand grasping under different forces. Methods CT scanning was performed on a volunteer’s hand, and CT data of his hand were imported into Mimics software for 3D reconstruction, so as to obtain the bone models of each segment. After adjusting the model coordinates by Geomagic Studio, the model was imported in AnyBody software for establishing the kinematics model of the hand skeleton. The related muscles involved in the flexion of each finger were added, to establish the skeletal muscle model of the hand. The model was then used to simulate the reverse dynamics of hand grasping. ResultsThe maximum muscle force of each muscle in the whole process of finger movement was obtained after the 5-30 N external force was applied to each distal phalanx. With the increase of force, the maximum muscle force of each muscle showed a linear trend. For example, the maximum muscle force of flexor pollicis longus increased from 18.49 N to 110.93 N; when the external force was 5 N, the maximum muscle force of flexor pollicis brevis, flexor pollicis longus, adductor pollicis and flexor digiti minimi brevis during hand grasping was 7.70, 18.49, 9.49, 8.39 N, respectively. The muscle force of superficial and deep flexors was greater than that of other muscles in the process of finger movement, which played a major role in grasping the hand. Conclusions The maximum muscle force of the muscles involved in hand grasping under different resistance, and the relationship between muscle force of main muscles and joint angles, can provide guidance and references for the evaluation of hand rehabilitation effect of stroke patients, as well as certain theoretical basis for the manufacture of rehabilitation equipment.

Objective:To investigate the expression level of vitamin D receptor (VDR) in podocytes of diabetic kidney disease (DKD) and its role in podocyte injury and proteinuria.Methods:(1) Sixty-five patients who had been diagnosed with type 2 diabetes mellitus (with or without albuminuria) were enrolled in this study and 25 age-and sex-matched healthy control subjects were enrolled. According to the ratio of urinary excretion of albumin/creatinine (ACR), the type 2 diabetes mellitus patients were classified into without proteinuria group (ACR<30 mg/g, n=24), microalbuminuria group (ACR 30-300 mg/g, n=18) and clinical proteinuria group (ACR>300 mg/g, n=23). Another 25 patients with DKD confirmed by renal biopsy were selected as the DKD group. Normal kidney tissue samples were taken from the same period of urinary surgical department for 10 cases of renal tumors in patients with renal resection. The test indicators in each group were compared. The VDR expression in blood, urine samples and kidney tissues of patients was detected by real-time quantitative PCR, ELISA and immunohistochemistry, and then were compared among different groups. The correlation between VDR and ACR was analyzed by Pearson correlation analysis. (2) Male db/db mice with genetic background of C57BLKs/J and db/m mice born in littermates were randomly divided into normal control group (group A), DKD control group (group B), DKD treated with dimethyl sulfoxide group (group C), DKD treated with paricalcitol (VDR agonist) group (group D). The C and D groups were treated by continuous intraperitoneal injection for 8 weeks, and the group A and B were not treated. The mice were started to intervene continuously for 8 weeks at the age of 10 weeks. At 22 weeks of age (12 weeks after starting intervention), the biochemical indexes of the mice's body weight, blood and urine were compared. The changes of β-catenin and VDR were detected by Western blotting. The expressions of podocyte marker protein podocin and podocyte injury protein α-SMA were observed by immunofluorescence. Results:(1) Compared with the normal healthy control group, the plasma levels of VDR mRNA and protein in diabetic patients without proteinuria, microalbuminuria and clinical proteinuria were lower (all P<0.05). Compared with the diabetic patients without proteinuria, the plasma levels of VDR mRNA and protein in diabetic patients with microalbuminuria and clinical proteinuria were lower (all P<0.05). (2) Compared with the normal healthy control group, the plasma levels of VDR mRNA and protein in diabetic patients without proteinuria and DKD patients were lower (all P<0.05). Compared with diabetic patients without proteinuria, the plasma levels of VDR mRNA and protein in the DKD group were also lower (both P<0.05). (3) Immunohistochemical results showed that the expression of VDR in kidney tissue of DKD group was significantly lower than that of normal control group. (4) The relative level of VDR mRNA in plasma of patients with DKD was negatively correlated with ACR ( r=-0.342, P<0.05). (5) The levels of VDR in urine supernatant of each group showed opposite trends with the plasma levels. (6) Western blotting results showed that the expression of β-catenin protein in groups B and C was higher than that in group D (both P<0.05), and the expression of VDR protein was lower than that in group D (both P<0.05). Immunofluorescence results showed that the expression of podocin in groups B and C was lower than that in group D (both P<0.05), and the expression of α-SMA was higher than that in group D (both P<0.05). Conclusion:VDR overexpression relieves podocyte injury and proteinuria in DKD.