Objective To understand the impairment and compensation mechanism of brain function in pa-tients with non-fluent aphasia after ischemic stroke. The fractional amplitude of low frequency fluctuation (fALFF) method was used to analyze the functional magnetic resonance imaging (fMRI) data in the resting state between the aphasia patients and the normal controls. Methods The scans of the resting state of fMRI were performed in 17 aphasia patients and 19 age-, education-, and sex-matched healthy control subjects. The scan sequence was single-shot echo planar image,DPARSF software was used to analyze fALFF data of the aphasia patients and the healthy controls. Results Compared to the control group, the value in right superior temporal gurus, inferior parietal lob-ule, frontal lobe cortex, and postcentral gurus were significantly increased in the aphasia group. The fALFF in bilat-eral cerebellum and right thalamus were also decreased in the aphasia group. Conclusions The fALFF values in some brain region in the aphasia group were abnormal in the resting state , indicating a few pathological change of brain function in patients with non-fluent aphasia after ischemic stroke.

Objective To investigate the relationship between plasma homocysteine (Hey) level and ankylosing spondylitis (AS).To analyze the association between the NS,N10 methylenetetrahydrofolate reductase (MTFHR) gene polymorphism and AS.Methods One hundred patients with AS and 60 healthy controls were included in the study.The plasma Hey level was examined by enzyme-linked immunoadsorbent assay and MTHFR gene polymorphism was analyzed by the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).Results Compared with heahhy controls,the plasma Hey level in AS patients was significantly higher than that of the controls (P＜0.01).There was no significant difference in the frequen-cies of MTHFR genotype and alleles between AS and the controls (P＞0.05),But the ratio of T/T genotype mutation was different between AS and the controls (P＜0.05).The plasma Hey level of T/T genotype was significantly higher than that of C/T or C/C genotype in AS and the controls (P＜0.01).Logisticalregression analysis indicated that Hey was an independent risk factor for AS (P＜0.01,0R=4.582,95%CI=1.984～10.585).Conclusion The plasma homocysteine level is significantly increased in AS patients.Hyperhomo-cysteinemia is an independent risk factor for AS.MTHFR T/T genotype mutation is an important mechanism of hyperhomocysteinemia and may be related with AS.

Objective To evaluate the clinical efficacy and safety of tapering the dosage of recom-binant human tumor necrosis factor receptor-Fc fusion protein (rhTNFR-Fc) combined with DMARDs in the treatment of peripheral joints involvement of ankylosing spondylitis. Methods Sixty patients who met the classification criteria of ankyloding spondylitis were enrolled. Meanwhile, all patients had one or more of the following joint involvement: hip, knee, ankle, and shoulder. Their BASDAI was higher than 4, joint pain VAS≥4, ESR ≥30 mm/1 h and CRP≥8 mg/L. Tuberculosis, hepatitis B, hepatitis C infection or other microorgan-isms infections were excluded. All enrolled patients had no serious heart,liver,kidney, or other internal organ involvement. During the first stage (The first eight weeks patients were matched by age and, disease activity, then randomly divided into the rhTNFR-Fc (the control group) treatment group in which patients were treated with 25 mg rhTNFR-Fc subcutaneous injection twice per week for 4 months) and rhTNFR-Fc dosage tapering group in which 25 mg rhTNFR-Fc were subcutaneously injected once per week for 4 weeks and then followed by 12.5 mg per week for 4 weeks, then once every 10 days for 6 times. Then the dosage of rhTNFR-Fc dosage of the dosage tapering group (the experimental group) was changed to 12.5 mg subcutaneous injection once every 15 days for another 4 times combined with methotrexate 7.5 mg per week and Salfasalazine 2 g daily and thalidomide 100 mg per night. The second stage started from week 9 to 24. In addition to the 30 cases at the first stage, 42 cases were included based on the same inclusion criteria for stage one. Patients' clinical and laboratory parameters were evaluated at week 0, 4, 8, 16 and 24. Results During the first four weeks, all patients of both control group and experimental group reached ASAS20, 97% (29/30) patients reached ASAS50 in the control group, 83% (25/30) patients reached ASAS50 in the experimental group. At week 8, patients in both groups maintained at 100% ASAS20 improvement, 100% (13/13) patients in the control group reached ASAS50, and that of the experimental group was 97% (29/30), the differences between the two groups were not statistically significant (P>0.05). In the second stage, 72 cases (100%) could achieve ASAS20, 63 cases (88%) achieved ASASSO at week 16. At week 24, 72 cases (100%) remained to achieve ASAS20, 71 cases (99%) achieved ASAS50. The safety and compliance of the two groups were good. Two cases developed infection, one patient had mild elevation of serum transaminase. Conclusion Tapering the dosage combined with DMARDs is an effective and safe approach in the treatment of peripheral joints involvement of ankylosing spondylitis. The compliance of this strategy is good and only few patients have serum transaminase elevation. But attention should be paid to the increased rate of infection.

ObjectiveTo investigate distingwished clinical and experimental characteristics of the four main subtypes in myelodysplastic/myeloproliferative neoplasms (MDS/MPNs).MethodsMDS/MPNs 53 cases from Provincial Hospital Affiliated to Shandong University,including 24 cases CMML,13 cases aCML,12 cases JMML,4 cases MDS/MPN-U,were analyzed regarding to 2001 WHO classification.Morphology (M) of peripheral and bone marrow blood cells were observed under microscope.FCM was used in immunological(Ⅰ) analyse on blasts and myelomonocytes in peripheral blood and bone marrow.G-banding technique was used in cytogenetic (C)examination.PCR was used in molecular genetic (M) mutation detection.Numeric data,such as mean Hb,WBC,PLT et al,among several groups,were compared using Single-factor analysisof variance.Student-Newman-Keulstestwasuseincomparingmeansof two groups.Proportions,such as percentage of clinical features,immunological and cytogenetic abnormal cases among different groups,were compared using Chi-square test or Fisher exact test.Results( 1 ) In the course of MDS/MPNs,there were 46 cases (86.8％ ) had paleness and fatigue 33 cases (62.5％ ) had palpable spleen.JMML had most fever and enlargement of lymph node (75.0％,75.0％ ),statistically distinguished from CMML ( 12.5％,12.5％ ) (x2 =14.89,17.98,P ＜ 0.05 ).(2) The hemoglobin was ( 83.1 ± 24.6 ) g/L.WBC counts were ( 19.8 ± 8.1 ) × 109/L.PLT counts were ( 158.7 ± 108.2) x 109/L.Immature neutrophils and blasts were found in peripheral blood.(3)JMML and CMML had most monocytes absolute counts among the subtypes (4.25 ±0.76) (3.62 ±0.76).(4) Almost 100％ JMML had monocytes abnormalities.(5)For 15 cases were detected immunological characteres by FCM,13 cases showed abnormalities.(6)For 29 cases of MDS/MPNs had been analyzed chromosome karyotypes and 12 out of them (41.4％) were abnormal,Ph chromosomes and those AML-defining translocations were all negative,+ 8 and 7-involved- karyotypes were more frequent.(7)23 cases were detected molecular genetic features,in which were all negative.BCR/ABL1 and JAK2 V617F mutation were all negative in the 13 cases of aCML.JAK2 V617F mutation was positive in 1 case of MDS/MPN-U.ConclusionsMost MDS/MPNs had paleness and fatigue,light to mild anemia,cytosis,monocytes low grade of blast and immature neutrophils in peripheral blood with dysplasia in bone marrow.JMML seems has more severe clinical features and more distinguishing laboratory characters.Immunological abnormalities and abnormalkaryotypes are found frequently in MDS/MPNs with no statistical differences among the four subtypes.There is no specific molecular abnormals in MDS/MPNs.( Chin J Lab Med,2012,35:832-837)

This article summarized the overview of nurse prescription rights, its implementation status at home and abroad and facilitators in implementation process. The aim was to arouse the attention of the healthcare service system and medical and nursing workers to the development of nurse prescription rights, and promote the promotion and practice of nurse prescription rights in China.

Objective:To integrate qualitative research on the experience of parents of children with cancer participating in shared decision-making, so as to provide reference for medical and nursing staff to support the participation of parents of children with cancer in shared decision-making.Methods:The qualitative research on the experience of parents of children with cancer participating in shared decision-making was searched on China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, Embase, and CINAHL from the establishment of database to February 2023. The literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center. The aggregation integration method was used to integrate the results.Results:A total of 14 articles were included, with 56 themes extracted and categorized into nine categories, forming four integrated results, including strong willingness of parents of children with cancer to participate in shared decision-making, differences in the participation of parents of children with cancer in shared decision-making, obstacles to parents' participation in shared decision-making, and the need for multiple parties to support the participation of parents of children with cancer in shared decision-making.Conclusions:The participation of parents of children with cancer in shared decision-making needs to be based on the current situation of decision-making in the field of pediatric cancer in China, and a localized decision support system should be constructed. Medical and nursing staff should enhance their awareness of shared decision-making, solve the practical dilemma of parents of children with cancer participating in shared decision-making, meet their diverse information, emotional, and social needs, and provide supportive care.

Objective To understand the pathological mechanism of brain function in irritable bowel syndrome (IBS) patients by analyzing the fraction amplitude of low-frequency fluctuation (fALFF) of functional magnetic resonance imaging (fMRI) raw data in resting state.Methods The fMRI at resting state was performed in 21 IBS patients and 21 age-,education-and sex-matched normal healthy subjects,collected in our hospital from August 2010 to April 2012.The scan sequence in this study was single-shot echo planar image.The DPARSF software was used to preprocess the fMRI data,and then,the fALFF was compared between the IBS and normal control groups.Results As compared with the control group,the IBS group showed significantly increased fALFF values in the primary somatosensory cortex region and secondary somatosensory cortex region such as right temporal pole,middle temporal gyrus,precentral gyrus,postcentral gyrus and right superior frontal gyrus,and decreased fALFF values in the cerebellum.Conclusion Some somatosensory cortex regions in the IBS group are abnormal in the resting state in IBS patients,which can reflex a few pathological changes of brain dysfunction,and it also helps to understand IBS from the perspective of the brain neural activity for clinic diagnosis.

Background: Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. Methods: Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A ques-tionnaire was developed to collect the patients’clinical data, as well as information on the diagnosis and manage-ment of bone metastases. Physicians’awareness of the guidelines and knowledge of the application of BP were also assessed. Results: A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gas-trointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gas-trointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efcacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. Conclusions: Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China.

Objective To investigate the incidence of osteonecrosis of the femoral head (ONFH) in divers of Dalian.Methods From January 2010 to December 2010,all registered 855 divers in Dalian were enrolled in this study.All divers underwent a unified medical examination and a questionnaire including height,weight,blood pressure and hip inspection.Radiological examination (anteroposterior and frog position)was used for all divers.Suspicious persons with hip pain but normal X-ray performance were confirmed by MRI.Results Sixty-eight divers were confirmed as ONFH,and the incidence of ONFH in divers of Dalian was 7.95％.According to the Ficat classification,12 patients (12 hips) were in Phase 1,40 patients (47 hips)in phase Ⅱ,3 patients (3 hips) in phase Ⅲ,13 patients (15 hips) in phase Ⅳ.The mean age of divers was 32.6+5.5 years (range,18-55 years).The onset ages of most patients ranged from 30 years to 50 years,accounted for 83.82％ (57/68).Among all patients,primary school education accounted for 10.58％ (38/359),junior high school education 6.28％ (28/446),high school education 4.26％ (2/47),university education 0 (0/3); seniority less than 5 years accounted for 4.55％ (20/440),6-10 years 9.69％ (28/289),11-15 years 13.04％ (12/92),16-20 years 21.05％ (4/19),more than 20 years 26.67％ (4/15); self-employed accounted for 11.88％ (19/160),private enterprise 8.41％ (38/452),and national enterprise 4.53％ (11/243).Conclusion The incidence of ONFH is high in divers of Dalian,which is different in terms of age,seniority,level of education,enterprise nature.

To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours (group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146. 8 ±78. 5)h and(21. 7 ±9. 5)h in group A and group B respectively. Overall inhospital mortality was 8. 6％ and 2. 3％. Multivariate logistic analysis showed that BMI(OR = 5. 956, 95％ CI: 2. 585 - 13. 723, P =0. 000), CPB time(OR =1. 108, 95％CI: 1. 052 -1. 166, P =0. 000), DHCA(OR =4. 562, 95％ CI: 1. 250 - 16. 640, P =0. 022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR =2. 625, 95％ CI: 1. 515 -4. 549, P =0. 001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.