Objective To explore the clinical characteristics of treatment?resistant depression ( TRD) and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non?TRD were as?sessed with 17?item Hamilton depression scale ( HAMD?17) and Hamilton anxiety scale ( HAMA) . The serum lev?el of thyroid?stimulating hormone ( TSH) ,total triodothgronine ( TT3) ,total thyroxine ( TT4) ,free triodothgronine ( FT3) and free thyroxine ( FT4) were determined by radioimmunoassay. χ2 test and t test were used for statistic a?nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non?TRD patients,the TRD patients showed a younger dis?ease onset age ((16.98±2.25)years vs (23.50±3.38)years) and a longer disease course ((10.14±6.47)years vs (5.48±4.15)years) for total disease course;(60.35±23.64)months vs (5.00±3.40)months for current disease course),and had shorter education years ((8.53±1.72)years vs (11.04±2.07)years) and higher HAMD total scores (19.09±1.59 vs 15.69±2.38) and behavior retarding factor scores (8.72±0.98 vs 4.98±1.63). In addition, the FT3 level of TRD patients was lower than that of non?TRD patients ((3.92±0.15)pmol/L vs (4.16±0.20) pmol/L).All the above differences between two groups were statistically significant (P<0.05). The logistic regres?sion analysis showed that the risk of suffering TRD increased by 1. 006?fold when FT3 level reduced 0. 1 pmol/L (OR=2.006,95%CI=(1.501,2.681). The area under ROC curve was 0.821 (P<0.001) with its 95% confidence interval of (0.734,0.907). Conclusion Compared with non?TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagnosis of TRD.

Objective To translate Moral Distress Scale(MDS-R), and to test the reliability and validity of the Chinese version of MDS-R. Methods The MDS-R was translated, back translation and adapted according to Chinese culture. The reliability and validity of Chinese version of MDS-R was tested in 750 nurses in Quzhou city by item correlation analysis, content validity, exploratory factor analysis, confirmatory factor analysis, Cronbach′s Alpha coefficient and test-retest reliability. Results The internal consistency coefficient of the Chinese version of MDS-R ranged from 0.119-0.756 (P<0.01). The content validity was 0.952. validity.Factor analysis extracted three common factors, which explained 64.537％ of variance of the total scale. Based on the exploratory factor analysis, a theoretical model was established for the scale and each factor, and the fitting degree of the theoretical model was verified by the data. After fitting the model, the fitness values of the first and the second order confirmatory factor analysis were all up to the standard level. The Cronbach's Alpha coefficient of the scale was 0.925, and the test-retest reliability was 0.900. Conclusions The Chinese version of MDS-R is reliable and valid, and can be used to measure the moral distress of nurses.

Objective:To investigate the pharmacological basis and mechanism of Anti-cancer Essence Formula in the treatment of gastric cancer based on network pharmacology,and to provide bioinformatics basis for the clinical treatment of gastric cancer with traditional Chinese medicine.Methods:The active ingredients of Anti-cancer Essence Formula were searched in TCMSP database,and the targets of the active ingredients were further obtained using UniProt database.The targets of gastric cancer were obtained using GeneCards,OMIM and TTD databases.Cytoscape 3.9.1 software was used to build the"Disease-Component-Target"network.String database and Cytoscape 3.9.1 software were used to construct the PPI network.The transcript levels of the core genes were analyzed by UALCAN database,and the relationship between core gene expression and patient survival was analyzed by Kaplan-Meier plotter.GO function and KEGG pathway enrichment analyses were performed by DAVID database.Results:There were 236 active ingredients of Anti-Cancer Essence Formula,and 16 key targets were screened by PPI network.MAPK3,MAPK1,RELA,AKT1,TP53,FOS,MAPK14,RXRA,MAPK8 and EGFR were abnormally expressed in gastric cancer tissues(P＜0.05),and all of them showed correlation with the prognosis of gastric cancer patients(P＜0.05).GO analysis was mainly enriched in cell division,cell proliferation and apoptosis,and KEGG analysis was mainly enriched in cancer pathway,MAPK signaling pathway,Relaxin signaling pathway,TNF signaling pathway,T-cell receptor signaling pathway,Prolactin signaling pathway,and PI3K-Akt signaling pathway.Conclusion:Anti-cancer Essence Formula is characterized by the synergistic effect of multi-components,multi-targets,and multi-pathways.It mainly acts on the targets of MAPK3,MAPK1,RELA,AKT1,TP53,FOS,MAPK14,RXRA,MAPK8,and EGFR through the active ingredients such as quercetin,kaempferol,β-sitosterol,and racemic carvacrol.It also regulates the signaling pathways of MAPK,Relaxin,TNF,T-cell receptor,Prolactin,and PI3K-Akt.

Objective:To explore the mechanism of kidney-protecting spirit pill for the treatment of diabetic nephropathy(DN)based on the network pharmacology and molecular docking technology.Methods:The database of TCMSP and Swiss Target Prediction was searched to obtain the active ingredients and targets of kidney-protecting spirit pill,and the intersection with the disease targets was obtained.The protein-protein interaction(PPI)network of intersection targets was constructed,GO and KEGG enrichment were analyzed.The key targets and small molecules were obtained and their interactions were verified by molecular docking.Results:A total of 60 active ingredients and 112 therapeutic DN targets were predicted.The key components were Cerevisterol,3,9-di-O-methylnissolin,Jaranol,Palmidin A and 16α-Hydroxydehydrotrametenolic acid.The key targets were PIK3CA,MAPK1,AKT1,PIK3R1 and BCL2,which were closely related to cancer-related pathways,AGE-RAGE signaling pathway,endocrine resistance,lipids and atherosclerosis pathways in diabetic complications.Conclusion:The mechanism of kidney-protecting spirit pill in the treatment of DN is characterized by multi-components,multi-targets and multi-pathways,with synergistic effects between the herbs,which provides a basis for the study of the pharmacological effects of kidney-protecting spirit pill.