Objective To explore the effectiveness of sandplay therapy combined with family counseling in children with school phobia and its influence of child′ self-consciousness. Methods Integrative sandplay therary with family consulting were used to treat 28 patients with school phobia regularly for 2 months. Sandplay and family consulting therapy were given once a week for 45 minutes . Clinical outcomes were assessed using CGI-GI and Piers-Harris children′s self-consciousness scale before and after treatment as well as 3 months posttreatment. Results Overall response rate was 85%. In addition, the physical appearance and characteristic factor before and after treatment were no significant difference (P>0.05). The rest of the various factors and total score compared with pre-treatment significantly improved (P<0.05). After treatment for 3 months, every factor in self-consciousness of children and total score were no significant difference (P>0.05). Conclusion Integrative sandplay therapy with family counseling has better and long-lasting treatment effect to self-consciousness of children with school refusal.

OBJECTIVE To analyze impulsive-like behaviors of SD rats induced by pramipexole in Y-maze avoidance tasks. METHODS Behaviors of SD rats in Y-maze avoidance tasks were recorded with a camera and analyzed by Noldus Etho Vision XT8 software after acute subcutaneous injection of pramipexole(0.1,1 and 10 mg · kg-1),including right reaction numbers of 20 consecutive avoidance tasks,shuttle number of times between the three arms of Y-maze, distance covered in Y-maze and time spent in safe arms during 20 consecutive avoidance tasks. Then,the prepulse inhibition(PPI)of the startle reflex test was used to assess the effect of pramipexole on sensorimotor gating (SG). Effects of pramipexole on the dialyzed content of monoamine neurotransmitter and its metabolites in the striatum and amygdala of SD rats were measured by microdialysis in vivo. RESULTS Compared with normal control group,the rats of pramipexole group showed a significant increase in the shuttle number of times and distance covered in Y-maze between Y-maze avoidance tasks(P<0.01),but a statistically significant decrease in the time spent in safe arms(P<0.01),while the number of right reactions in Y-maze avoidance tasks was not changed. Such premature responses were quite similar to certain impulsive-compulsive behaviors in rodent models,such as five-choice serial reaction time tasks. In the PPI test,pramipexole displayed an impairing effect on SG(P<0.01). The microdialysis results showed that there was an increase of dopamine and 5-hydroxytryptamine in the striatum of pramipexole group, but not statistically significant. Monoamine neurotransmitters and their metabolites were not significantly changed in the amygdala. CONCLUSION Pramipexole can induce impulsive-compulsive behaviors in Y-maze avoidance tasks,which might be attributed to impaired SG.

Objective To observe the effect of Zhongfengkang on the expression of Aquaporin 4 mRNA(AQP-4mRNA) in brain of focal cerebral ischemia rats. Methods The rat model of focal cerebral ischemia was established by inserting nylon thread.The dynamic changes of AQP-4 mRNA expression in the model group at 12th,24th,48th,72nd and 96th hour after cerebral ischemia were examined and the effect of Zhongfengkang on AQP-4 mRNA expression and cerebral edema at 48 th hour after cerebral ischemia was observed.Results At 12th hour after cerebral ischemia,the expression of AQP-4mRNA in the model group increased compared with the sham-operation group,and it arrived to the peak at 72th hour(P

Objective To investigate the guiding value of serum procalcitonin (PCT) level in antibiotic treatment of stroke-associated pneumonia (SAP) after spontaneous intracerebral hemorrhage. Methods A total of 120 patients with SAP after acute cerebral hemorrhage were enroled and were randomly divided into either a conventional treatment group ( n=59) or a PCT guided group ( n=61). In accordance w ith the guidelines for the use of antibiotics in China, the conventional treatment group w as treated w ith antibiotics and the course of antibiotics w as determined by the treating physician. The serum PCT of the PCT group w as monitored continuously after using antibiotics for 5 days. When PCT w as < 0.25 μg/L and the body temperature of the patients w as normal, the antibiotics w ere stopped. When PCT w as ≥0.25 μg/L, the antibiotics w ere used continuously. When PCT w as <0.25 μg/L, but stil had a fever, and the antibiotics w ere used continuously til the temperature w as normal. The course of antibiotics, length of hospitalization, and 30-d mortality of both groups w ere compared. At day 90 after treatment, the modified Rankin scale (mRS) w as used to evaluate the neurological outcome. The mRS score 0-2 w as good outcome and >2 w as poor outcome. They were folowed up for 6 months after discharge. A Kaplan-Meier survive curve was use to compare the survival rate of both groups. Results The course of antibiotics ( 8.95 ±2.73 d vs.13.26 ± 4.11 d;t=6.407, P<0.001) and the length of hospitalization ( 15.64 ±2.63 d vs.18.36 ±4.27 d; t=3.967, P<0.001) of the PCT group w ere significantly shorter than those of the conventional treatment group. There w ere no significant differences in the proportions of 30 d mortality ( 9.8%vs.10.1%; χ2 =0.003, P=0.951) and 90 d good outcome ( 60.6%vs.59.3%; χ2 =0.022, P=0.881) betw een the PCT guided group and the conventional treatment group. At the end of the 6-month folow-up period, a total of 13 patients (12.0%) died, including 6 in the conventional treatment group and 7 in the PCT group. The Kaplan-Meier analysis show ed that there w as no significant difference in the 6-month survival rate betw een the 2 groups (χ2 = 0.070, P= 0.791 ). Conclusions Monitoring the serum PCT level for guiding antibiotic treatment of SAP after spontaneous intracerebral hemorrhage is safe, and it may shorten the course of antibiotics and reduce the length of hospitalization.

Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.

In post-marketing study of traditional Chinese medicine (TCM), pharmacoeconomic evaluation has an important applied significance. However, the economic literatures of TCM have been unable to fully and accurately reflect the unique overall outcomes of treatment with TCM. For the special nature of TCM itself, we recommend that Markov model could be introduced into post-marketing pharmacoeconomic evaluation of TCM, and also explore the feasibility of model application. Markov model can extrapolate the study time horizon, suit with effectiveness indicators of TCM, and provide measurable comprehensive outcome. In addition, Markov model can promote the development of TCM quality of life scale and the methodology of post-marketing pharmacoeconomic evaluation.
Economics, Pharmaceutical ; Markov Chains ; Medicine, Chinese Traditional ; economics ; Product Surveillance, Postmarketing

Objective To identify the differences inneuropsychological characteristics between amnestic(AMCI)and vascular mild cognitive impairment(VMCI).Methods Totally 297 old community residents with mild cognitive impairment(MCI)were divided into amnestic MCI(AMCI)and vascular MCI(VMCI)subgroup from Guangzhou MCI prevalence survey.The elderly with MCI were interviewed and tested with the Chinese version of Montreal Cognitive Assessment(MoCA),the Mini-Mental state examination(MMSE),Auditory Verbal Learning Test(AVLT),the Clinical Dementia Rating scale(CDR),Functional Activity Questionnaire(FAQ),the Modified Hachinski Ischemic Scale(M-HIS),Center for Epidemiologic Studies(CES-DC)to evaluate neuropsychological characteristics.Results AMCI versus VMCI group showed that the total scores of MoCA were(9.63±5.17 vs.9.98±6.02),total scores of MMSE were(16.90±4.84 vs.16.90±6.19),AVLT immediate memory was(2.35±1.39 vs.2.91±1.84),AVLT delayed recall was(2.23±2.09 vs.2.47±2.20),AVLT delayed recognition was(7.33±3.98 vs.6.85±4.02)and total scores of CDR(0.5 vs.0.5),with no differences between the 2 groups(all P>0.05).Based on MoCA survey,AMCI versus VMCI group showed statistically significant differences(all P<0.05)in parameters of visual space and execution(0.71±1.02 vs.0.92±1.26),language function(0.34±0.56 vs.0.50±0.80)and abstract thinking(0.25±0.49 vs.0.15±0.43),but based on MMSE survey,no difference was found in the various cognitive domains between the two groups.The AMCI versus VMCI group showed statistically significant differences(all P<0.05)in parameters of CES-DC scale(1.75±4.27 vs.2.76±6.72),FAQ scale(4.42±4.66 vs.8.71±7.03),M-HIS scale(0.40±0.64 vs.7.59±3.53).Conclusions There is no significant difference in general cognitive impairment between AMCI and VMCI,but the visual space and execution,language function are more impaired in AMCI than VMCI,and the abstract thinking,social function are more impaired with more depressive symptoms in VMCI than in AMCI.

Objective To investigate the difference of Alzheimer-associated neuronal thread protein ( AD7c-NTP) level and related factors among different symptom types of schizophrenia. Methods The con-centrations of AD7c-NTP in urine of 30 patients with positive symptoms,46 patients with negative symptoms and 24 controls were detected by enzyme linked immunosorbent assay( ELISA) . Positive and negative symp-tom scale ( PANSS) was used to assess schizophrenia patients. The correlation analysis was conducted be-tween the urine AD7c-NTP and demographic factors. Results The level of AD7c-NTP in urine of patients with negative symptoms((0. 88±0. 93) ng /ml)was higher than that in the patients with positive symptoms ((0. 50±0. 22)ng/ml,P<0. 05). The level of AD7c-NTP of in urine female patients((1. 16±1. 12)ng/ml) was higher than that in the male patients((0. 57± 0. 49)ng/ml,P<0. 01). AD7c-NTP levels in patients with a course of disease of more than 100 months((0. 96±0. 96)ng/ml) were higher than those in patients with a course of disease of less than 100 months((0. 60±0. 59)ng/ml,P<0. 05). The level of AD7c-NTP in pa-tients over 35 years old((0. 94±0. 96)ng/ml) were higher than that in patients under 35 years old((0. 62±0. 62)ng/ml,P<0. 05). The level of AD7c-NTP in patients with MMSE score of 0-22 points((0. 92±0. 80) ng/ml) were higher than that in patients with score of 23-29 points((0. 62±0. 74)ng/ml,P<0. 05). Before admission(at least 2 months),the level of AD7c-NTP in patients without persisting in taking drugs((0. 99± 0.95)ng/ml) was higher than that in patients with persisting in taking drugs((0. 62±0. 65)ng/ml,P<0. 05). The level of AD7c-NTP in schizophrenic patients was positively correlated with age and course of dis-ease( r=0. 29,0. 26,P<0. 05) ,and negatively correlated with smoking history and mini-mental state exami-nation( MMSE) ( r=-0. 13,-2. 41,P<0. 05) . Conclusion There is a difference in AD7c-NTP levels be-tween patients with positive and negative symptoms of schizophrenia. Gender,age,course of disease and anti-psychotics are important factors that affect AD7c-NTP levels in patients with schizophrenia.

Objective:To compare the clinical efficacy of long/short segment posterior instrumentation combined with transpedicular impaction bone grafting for stage III Kümmell's disease.Methods:A retrospective case control study was conducted to analyze the clinical data of 45 patients with stage III Kümmell's disease admitted to Zhengzhou Orthopaedics Hospital from June 2012 to June 2019, There were 8 males and 37 females, aged 58-84 years [(68.8±3.5)years]. Segment of injury was T 11 in 5 patients, T 12 in 18, L 1 in 15, and L 2 in 7. A total of 24 patients were treated with posterior long segment pedicle screw fixation combined with pedicle screw compression and bone grafting (long segment group), and 21 patients were treated with posterior short segment pedicle screw fixation combined with pedicle screw compression and bone grafting (short segment group). For patients with severe osteoporosis, pedicle screws were augmented with bone cement. The operation time and blood loss were compared between the two groups. The visual analogue scale (VAS) was used to evaluate the degree of low back pain, and the Japanese Orthopaedic Association (JOA) score was used to evaluate the lumbar function at postoperative 2 weeks and 1 year. According to X-ray film and CT examination, the bone healing of the grafted vertebral body and the changes of Cobb angle of injured vertebrae were further evaluated. The complications were observed. Results:All patients were followed up for 15-48 months[(31.2±2.3)months]. There were no significant differences between the two groups in operation time and intraoperative blood loss ( P>0.05). The bone grafts in the vertebrae healed well in both groups at 1 year after operation. The Cobb angle, VAS and JOA score in both groups improved at 2 weeks and 1 year after operation ( P<0.01). There was no significant difference in Cobb angle, VAS and JOA score between the two groups at 2 weeks after operation ( P>0.05). The Cobb angle in short segment group [(14.8±6.3)°] was significantly higher than that in long segment group [(8.5±3.3)°] at 1 year after operation ( P<0.01), but there was no significant difference in VAS and JOA scores between the two groups ( P>0.05). There was no loosening or breakage of internal fixation in both groups. Conclusions:For stage III Kümmell's disease, both long and short segment posterior instrumentation combined with transpedicular impaction bone grafting can effectively restore the vertebral height, improve kyphosis and reduce dysfunction. However, long segment can better maintain spine stability, prevent vertebral collapse and progression of local kyphosis Cobb angle when compared with short segment fixation.

Objective:To explore the efficacy of stage I modified posterior vertebral column resection (mPVCR) in the treatment of postoperative infection after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective case series study was conducted to analyze the clinical data of 11 OVCF patients with post-PVP infection who were admitted to Zhengzhou Orthopedics Hospital from January 2016 to June 2022, including 4 males and 7 females, aged 61-81 years [(70.2±6.4)years]. Injured segments included T 9 in 1 patient, T 11 in 2, T 12 in 3, L 1 in 1, L 2 in 2, T 11-T 12 in 1, and T 12-L 1 in 1. American Spinal Injury Association (ASIA) grading was grade D in 5 patients and grade E in 6. All the patients were treated with stage I mPVCR. The operation time and intraoperative bleeding volume were recorded. The values of Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI), and Cobb angle of the lesion segments before, at 2 weeks, 3 months after surgery, and at the last follow-up were compared. The loss of Cobb angle of the lesion segments at 2 weeks after surgery and at the last follow-up were compared, and the ASIA grading at the last follow-up was recorded. The infection control, bone healing, and the incidence of complications were observed at the last follow-up. Results:All the patients were followed up for 12-44 months [(26.0±9.4)months]. The operation time and intraoperative bleeding volume were 230-330 minutes [(279.2±28.6)minutes] and 500-1 100 ml [(840.9±184.1)ml] respectively. At 2 weeks, 3 months after surgery and at the last follow-up, the VAS scores were (4.0±0.8)points, (2.7±0.9)points, and (2.4±0.7)points respectively, which were all lower than that before surgery [(8.1±1.2)points] ( P<0.01); the ODI was (45.5±5.1)%, (30.0±6.5)%, and (18.5±3.6)% respectively, which were all lower than that before surgery [(78.7±6.2)%] ( P<0.01); the Cobb angle of the lesion segments were (7.9±1.4)°, (8.5±1.4)°, and (9.2±1.5)° respectively, which were lower than that before surgery [(25.5±9.2)°] ( P<0.01). The VAS and ODI were both improved at 3 months after surgery compared with those at 2 weeks after surgery ( P<0.05), while there was no significant difference in Cobb angle of the lesion segments ( P>0.05). The ODI was further improved at the last follow-up compared with that at 3 months after surgery ( P<0.05), while there were no significant differences in VAS or Cobb angle of the lesion segments ( P>0.05). The loss of Cobb angle correction of the lesion segment at the last follow-up was 0.96 (0.69, 1.45)° compared with that at 2 weeks after surgery and the rate of loss of Cobb angle correction of the lesion segment was 4.4(2.2, 7.4)%. At the last follow-up, the ASIA grading was grade E for all the patients, who were able to walk normally independently. The infection was all cured and good bony fusion was observed in the operated area at the last follow-up. Two patients had pleural effusion and pulmonary atelectasis, 1 incision fat liquefaction, and 1 pneumonia after the surgery. None of the patients had internal fixation failure and serious complications such as worsening neurological symptoms or death. Conclusion:Stage I mPVCR for the treatment of post-PVP infection in patients with OVCF is proved to attain significant pain relief and functional improvement, good correction results, effective reconstruction of spinal stability, complete removal of infected lesions, and few serious complications.