Objective To explore the changes of peripheral serum glial-derived neurotrophic factor (GDNF) levels in children with attention deficit hyperactivity disorder(ADHD),and to provide a new mark-er for early identification of ADHD in clinical practice. Methods Totally 42 drug-naive children with ADHD(ADHD group) and 45 healthy children(HC group) were included. General demographic informa-tion,scale scores,and fasting peripheral serum GDNF levels were compared between the two groups. Mean-while,the correlation between GDNF level and symptom severity score of children with ADHD was analyzed. Results There were significant differences in FSIQ,attention deficit, and hyperactivity/impulsivity scores between ADHD group and HC group(FSIQ(105. 26±13. 82) vs (114. 73±9. 93); attention deficit(23. 60± 5. 06) vs (20. 04±2. 85); hyperactivity/impulsivity(19. 43±3. 47) vs (15. 93±2. 42),all P<0. 05). Serum level of GDNF in the ADHD patients was significant lower than that in the HC group ((442. 52± 70. 01) pg/ml vs (554. 02±101. 37)pg/ml,P<0. 01). In addition,GDNF levels were negatively correlated with at-tention deficit scores in children with ADHD (radj=-0. 447,P<0. 01). More importantly,ROC curve results show that GDNF had good diagnostic value (AUC=0. 81). Conclusion GDNF levels decreased child with ADHD. Decreased serum GDNF levels have certain promising value in the diagnosis of ADHD.

Objective: To explore the changes in brain structure network connection in children with attention deficit hyperactivity disorder(ADHD), and to provide novel markers for early identification of ADHD in clinical practice. Methods: Deterministic diffusion-tensor tractography and graph theory approaches were used to investigate the topologic organization of the brain structural connectome in 25 children with ADHD and 23 healthy control children from May 2017 to May 2018, at Children′s Hospital of Xuzhou Medical University.Individual white matter networks were constructed for each participant, then the global properties, nodal properties and edge-wise distributions were compared between the two groups. Results: (1)The global efficiency of the ADHD group (0.30±0.13) was significantly lower than that of the healthy control group (0.38±0.11), but the clustering coefficient (0.35±0.28) and the characteristic path length (2.94±0.38) were significantly higher than those of the healthy control group (0.28±0.10, 2.65±0.37), and the differences were statistically significant (t=-2.41, 2.31, 2.62, all P<0.05). (2)In the ADHD group, the nodal efficiency of the left inferior frontal gyrus, triangular part (0.13±0.06), left supramarginal gyrus (0.30±0.10), left inferior parietal, angular gyri (0.29±0.10), left precuneus (0.26±0.12)were significantly lower than the healthy control group(0.17±0.07, 0.38±0.10, 0.40±0.12, 0.35±0.12), while the nodal efficiency of the right superior frontal gyrus, orbital part and right paracentral lobule were significantly higher than the healthy control group(0.49±0.17, 0.43±0.14), and the differences were statistically significant[t=-2.52, -2.62, -3.11, -2.77, 2.34, 2.79, all P<0.05, false discovery rate(FDR) corrected]. (3)A disrupted subnetwork was observed that consisted of left frontoparietal areas, basal ganglia, thalamus and insular network (P<0.05, FDR corrected), which has the potential to discriminate individuals with ADHD from healthy control children(area under receiver operating characteristic curve was 0.78). (4)Diminished strength of the subnet work connections was correlated with the attention defect in patients with ADHD(r=-0.607, P=0.003). Conclusions Using magnetic resonance diffusion tensor imaging, with the help of graph theory analysis technology, ADHD children can be observed changes in brain structure network at multiple levels.The distribution pattern of brain network structure connection changes is expected to become a new marker for identifying ADHD.

Objective:To explore the correlation between executive dysfunction and serum glial-derived neurotrophic factor (GDNF) levels in children with attention deficit hyperactivity disorder (ADHD).Methods:32 drug-free ADHD patients and 34 normal children matched in gender, age and IQ were included.The executive function was assessed using Digital Span Back Test (DSB-T), Trail Making Test (TMT), Semantic Fluency Test (SFT) and Stroop Color Word Test (SCW-T), and peripheral GDNF levels were measured by the enzyme linked immunosorbent assay (ELISA). The executive functional test scores and serum GDNF levels were compared between groups, and then the correlation between executive dysfunction and GDNF was analyzed by Spearman or pearson correlation analysis.Results:(1) In the ADHD group, the DSB-T and SFT scores were lower than those in the normal control group(DSB-T4: (2) vs 5(1); SFT(13.66±2.34) vs (15.21±2.13)( Z=3.16, t=2.82, both P<0.05) and the TMT-A and TMT-B time-consuming were higher than those in the normal control group(TMT-A(61.12±19.03)s vs (48.76±21.06)s; TMT-B(158.66±63.78)s vs (123.62±45.24)s, t=2.50, 2.59, both P<0.05). The Word color consumption, word interference and word color errors of SCW-T in ADHD group were higher than those in the normal control group(Word color consumption(56.41±21.65)s vs (45.97±13.42)s; word interference 27(25)s vs 20(15)s; word color errors 4(3) vs 2(1)), and the differences were statistically significant( t=2.37, Z=2.31, 2.11, all P<0.05). (2) Serum levels of GDNF in the ADHD group were lower than that in the normal control group((481.59±68.74)pg/ml vs (552.47±110.13)pg/ml) , and the difference was statistically significant ( t=3.11, P<0.05). (3) In the ADHD group, serum GDNF levels were negatively correlated with TMT-A, TMT-B and SCW-T word interference performance ( r=-0.512, r=-0.578, r=-0.432, all P<0.05), and positively correlated with DSB-T performance( r=0.381, P<0.05). Conclusion:Executive function is extensively damaged in ADHD patients, and GDNF may be involved in the pathophysiology of executive impairment.

The authors introduced a pharmaceutical care mode by establishing a medication management platform(" Smart Pharmacists" platform), automatically and regularly sending personalized medication reminders for out-of-hospital patients. In virtue of the medication consultation service built on mobile internet technology, the hospital information system was seamlessly connected with the WeChat public account of the hospital, hence broadening pharmaceutical care. The " Smart Pharmacists" platform covered such six parts as medication reminder, medication record, voice broadcast, medication consultation, prescription query, and package insert inquiry. It serves as a reminder of taking medicine for patients out of the hospital and provides an accessible " pharmacist-patient interaction" service window, which will guarantee the safety and effectiveness of medication for out-of-hospital patients.

Objective: Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadoliniumenhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods: Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing mocoss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. Results: The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). Conclusion Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.

Objective: Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadoliniumenhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods: Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing mocoss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. Results: The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). Conclusion Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.

Objective:To analyze the effect of analysis plan, do, check, and action (PDCA) cycle in improving the completion rate of sepsis bundle treatment in sepsis patients and the knowledge-attitude-practice of sepsis bundle treatment in medical staff.Methods:Using the historical control method, sepsis patients admitted to the Emergency Trauma Intensive Care Unit of Shandong Provincial Hospital Affiliated to Shandong First Medical University were selected as the research objects by convenience sampling. The 35 patients admitted from January to December 2021 will be included in the control group; from June 2022 to June 2023, 28 patients were admitted to the observation group. The control group received routine nursing care, while the observation group received intervention based on the PDCA cycle. The completion rate of sepsis bundle treatment before and after PDCA cycle implementation was compared. The 27 nurses and 5 doctors working in trauma care unit were investigated by using a self-designed questionnaire on their knowledge and practice level of sepsis bundle treatment. The completion rate of sepsis bundle treatment before and after the implementation of PDCA cycle was compared.Results:The control group included 19 males and 16 females, aged (61.77 ± 8.64) years. The observation group included 13 males and 15 females, aged (60.61 ± 10.20) years. After the implementation of PDCA cycle, the completion rate of 3h bundle treatment for sepsis in the observation group was 89.29% (25/28), which was higher than 31.42% (10/35) in the control group, with a statistically significant difference ( χ2=23.22, P<0.05). The completion rate of sepsis bundle treatment within 6 hours in the observation group was 11/11, which was higher than 5/9 in the control group, with a statistically significant difference ( χ2=6.11, P<0.05). Moreover, after the implementation of PDCA cycle, the total score and sub-scale scores of the knowledge-attitude-practice among medical staffs increased from 86.60 ± 10.33, 21.00 ± 4.74, 18.00 ± 1.58, and 47.60 ± 4.10 to 100.00 ± 5.20, 27.60 ± 2.51, 19.60 ± 0.55, and 52.80 ± 2.28 respectively, with statistically significant differences ( t values were -5.10 - -3.14, all P<0.05). Conclusions:PDCA cycle can improve the completion rate of sepsis bundle treatment and improve the level of knowledge, attitude and practice of medical staff.

Objective:To explore the path relationship among medical narrative competence and profession quality of life on professional identity of nurses, so as to provide reference for improving nurses ′professional identity. Methods:This study was across-sectional survey. From October 2022 to February 2023, totally 619 nurses in Shandong Provincial Hospital Affiliated to Shandong First Medical University were investigated using Self-designed Demographic Questionnaire, Medical Narrative Competence Scale, Professional Quality of Life Scale and Professional Identity Scale.Results:The score of nurses ′s medical narrative competence was (144.13 ± 22.09) points, compassion satisfaction was (34.82 ± 6.96) points, job burnout was (24.03 ± 5.48) points, secondary traumatic stress was (23.91 ± 5.89) points, and the scores of nurses ′ professional identity was (112.68 ± 19.05) points. Nurses ′ medical narrative competence was positively correlated with compassion satisfaction and professional identity ( r=0.585, 0.697, both P<0.01); nurses ′ medical narrative competence was negatively correlated with job burnout and secondary traumatic stress ( r=-0.516, -0.214, both P<0.01). Regression analysis showed that nurses ′ medical narrative ability, compassion satisfaction and job burnout were the influencing factors of nurses ′professional identity ( t=13.26, 10.52, -2.32, all P<0.05). Structural equation model indicated that medical narrative ability of nurses had an intermediary effect on professional identity through the dimension of compassion satisfaction, and the intermediary effect was 0.269, and the intermediary effect accounted for 36.88% of the total effect. Conclusions:Medical narrative ability of nurses can have positive emotional experience on nurses ′ psychology, and thus have an impact on professional identity. Nursing managers should pay attention to the level of nurses ′ medical satisfaction, and give full play to the intermediary effect of compassion satisfaction in nurses ′ medical narrative ability and professional identity.

Objective:To explore the chain mediating effect of basic activity of daily living and nutritional status the effects on comorbidity and frailty, so as to provide guidance for preventing and delaying the frailty of elderly patients with cardiovascular disease and abnormal glucose metabolism.Methods:The cross-sectional study method was adopted, 300 elderly patients with cardiovascular disease and abnormal glucose metabolism who were hospitalized in the cardiovascular medicine ward of Shandong Provincial Hospital Affiliated to Shandong First Medical University, were selected as the study objects from January to August 2022, and were surveyed using General Information Questionnaire, Frailty Scale, Charlson Comorbidity Index Scale, Barthel Index Rating Scale and Mini Nutritional Assessment-Short Form were used to investigate them.Results:A total of 300 questionnaires were collected and 291 valid questionnaires were returned. Out of 291 patients, 167 were male and 124 were female, with an age of (69.55 ± 7.01) years. Comorbidities in elderly patients with cardiovascular disease and abnormal glucose metabolism were positively correlated with frailty ( r=0.414, P<0.01), and negatively correlated with basic activity of daily living and nutritional status ( r=-0.399, -0.373, both P<0.01). Basic activity of daily living was positively correlated with nutritional status ( r=0.575, P<0.01) and negatively correlated with frailty ( r=-0.825, P<0.01). Nutritional status was negatively correlated with frailty ( r=-0.695, P<0.01). The chain mediating model showed that comorbidities had a significant direct effect on frailty (effect value of 0.102), basic activity of daily living partially mediated between comorbidity and frailty (effect value of 0.125). Basic activity of daily living and nutritional status partially chained between comorbidity and frailty (effect value of 0.036). Conclusions:The chain mediating roles of basic activity of daily living and nutritional status between comorbidity and frailty was established. Healthcare professionals should pay attention to the improvement of basic activity of daily living in elderly patients with cardiovascular diseases and abnormal glucose metabolism, guide them to have a reasonable diet to achieve balanced nutrition, and delay the onset and development of frailties.