OBJECTIVE:To observe clinical efficacy and safety of escitalopram combined with ozagrel sodium for elderly pa-tients with acute cerebral infarction complicated with anxiety and depression. METHODS:140 elderly patients with acute cerebral infarction complicating with anxiety and depression were divided into control group and observation group according to random number table method,with 70 cases in each group. Control group received routine treatment and Sodium ozagrel for injection 40-80 mg added into 0.9% Sodium chloride injection 500 ml,ivgtt,bid. Observation group was additionally given Escitalopram tablet 10 mg,qd. Both groups received treatment for 8 weeks. HAMA,HAMD,NIHSS and BI were compared between 2 groups before and after treatment,and clinical efficacy and the occurrence of ADR were observed. RESULTS:There was no statistical sig-nificance in HAMA,HAMD,NIHSS,BI before treatment and NIHSS,BI 1 week of after treatment between 2 groups(P>0.05). HAMA and HAMD of observation group 1,4,8 weeks after treatment,and NIHSS and BI of it 4,8 weeks after treatment were improved significantly;above indexes of control group were improved significantly 4,8 weeks after treatment,and the observation group was better than the control group,with statistical significance (P<0.05). The total effective rate of observation group was 87.14%,which was significantly higher than 74.29% of control group,with statistical significance(P<0.05). There was no statis-tical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Escitalopram combined with ozagrel so-dium is significantly effective for elderly patients with acute cerebral infarction complicated with anxiety and depression,and can significantly improve anxiety,depression and neurological function with good safety.

Objective To evaluate the application of three dimensional time-of-flight (3D-TOF) MRA in screening intracranial aneurysms in the population of Wenling community. Methods A total of 2 124 patients with suspicious intracranial aneurysm in Wenling community, who received 3D-TOF MRA and three dimensional digital subtraction angiography(3D-DSA) during the period from September 2011 to August 2012, were enrolled in this study. The epidemic data of intracranial aneurysm in Wenling community were analyzed, the effectiveness of 3D-TOF MRA in detecting intracranial aneurysm was assessed, and the consistency between 3D-TOF MRA and 3D-DSA (regarded as the golden standard) in detecting intracranial aneurysm was statistically analyzed. Results The results of 3D-TOF MRA showed that the morbidity of intracranial aneurysm in the population of Wenling community was 6.87% (146/2 124), among which the morbidities in males and females were 48.63% (n=71) and 51.37% (n=75) respectively; the mean age of patients was (41.2±11.6) years old. The accompanying diseases included hypertension, diabetes mellitus, arteriosclerosis and cerebrovascular lesions. 3D-TOF MRA examination revealed 149 intracranial aneurysms, among which misdiagnosis was made in 5 patients and missed diagnosis in 2 patients. The sensitivity, specificity and accuracy of 3D-TOF MRA in diagnosing intracranial aneurysm were 98.63% (144/146), 99.72%(1 773/1 778) and 99.67%(2 117/2 124) respectively. No statistically significant difference in measuring the longitudinal diameter and neck width of intracranial aneurysms existed between 3D-TOF MRA and 3D-DSA examinations (P>0.05). Conclusion In detecting intracranial aneurysm, 3D-TOF MRA carries higher sensitivity, specificity and accuracy, and its non-invasive advantage is more suitable for the screening of intracranial aneurysms.

Objective To investigate the effects of butylphthalide soft capsules on cognitive function and daily living ability in patients with Parkinson's disease dementia(PDD). Methods From January 2016 to January 2017, 90 patients with PDD in the First People's Hospital of Wenling were divided into control group and study group by random number table method,with 45 cases in each group. The patients in the two groups were treated with conventional symptomatic treatment, and the control group was treated with donepezil, the study group was treated with butylphthalide soft capsules on this basis. The treatment time was 12 weeks. The clinical efficacies of the two groups were compared. Before treatment and 12 weeks after treatment,the cognitive functions of patients were assessed by Montreal cognitive assessment scale (MoCA) and mini - mental state examination (MMSE),and the daily living abilities of patients were assessed by Barthel index scale. Results The total effective rate of the study group was 93. 33％ ,which was higher than 75. 56％ of the control group (χ2 = 5. 414,P < 0. 05). 12 weeks after treatment,the scores of MoCA and MMSE scales in the two groups were (20. 54 ±2. 53)points,(18. 95 ± 2. 63)points,(23. 53 ± 2. 87)points,(22. 53 ± 2. 62)points,respectively,which were significantly higher than those before treatment[(16. 78 ±2. 34)points,(16. 03 ± 2. 24)points,(16. 23 ± 2. 78)points,(15. 23 ± 2. 34)points](t = 2. 863,2. 735,3. 062,3. 178,all P < 0. 05),and the scores of MoCA and MMSE scales in the study group were higher than those in the control group (t = 2. 798, 2. 753,all P < 0. 05). 12 weeks after treatment,the Barthel scores of the two groups were (64. 43 ± 5. 89) points, (76. 33 ± 5. 23 ) points, respectively, which were significantly higher than those before treatment [( 59. 34 ± 4. 83)points,(58. 26 ± 6. 65)points](t = 2. 916,3. 203,all P < 0. 05),and the Barthel score in the study group was higher than that in the control group (t = 2. 835,P < 0. 05). The incidence rate of adverse reaction in the control group was 6. 67％ ,which in the study group was 8. 89％ ,there was no statistically significant difference between the two groups (χ2 = 0. 155,P > 0. 05). Conclusion Butylphthalide soft capsules can significantly improve the cognitive function and daily living ability of patients with PDD,which is suitable for clinical application and promotion.

Objective To explore the effect of whole renal perfusion imaging removal of arterial phase data on perfusion parameters of renal clear cell carcinoma using Revolution CT.Methods Perfusion imaging with Revolution CT was retrospectively analyzed in 10 patients with pathologically proven clear cell renal cell carcinoma.The z-direction coverage model was used in perfusion imaging,and the images were analyzed with CT Perfusion 4D software.All images were analyzed twice.All 23 phases data was included in group A and only 16 phases except arterial data (9-15 phases) were selected in group B.The abdominal aorta on the level of right hilus was chosen to be the input artery,and the perfusion parameter maps were obtained,including blood flow (BF),blood volume (BV),mean transit time (MTT),permeability of surface (PS).Every perfusion parameters of lesions and contralateral normal cortex,lesions and normal cortex in both groups were compared.Results The BF and PS of lesions were lower than those of normal cortex in both groups (both P＜0.05).There was no statistical difference in BV and MTT between lesions and normal cortex in both groups (all P＞0.05).There was no statistical difference in all perfusion parameters of renal clear cell carcinoma between group A and group B (all P＞0.05).The difference of BF in normal cortex between the two groups was statistically significant (P 0.009),and the difference of the PS,BV,MTT had no statistically significant (all P＞0.05).Conclusion When the duration time of renal CTP is 600 s,there is no difference between including and excluding arterial phase in all perfusion parameters of renal clear cell carcinoma.

Objective · To identify broad-spectrum bacteriophages against extensively drug-resistant Klebsiella pneumonia and analyze their characteristics by biological and genomic methods. Methods · Multi-drug resistant Klebsiella pneumonia strains collected from a hospital were used as host bacteria to isolate and purify broad-spectrum phages in the wastewater at the same hospital area. The size and shape of phages were observed by transmission electron microscope. Titer, host range, pH stability and thermal stability were measured. Moreover, the DNA extracted from the phage SH-Kp152234 was sequenced and analyzed. Results · One strain of bacteriophage against Klebsiella pneumonia was isolated and named as SH-Kp152234. The electron microscope revealed it belongs to Podoviridae family. Moreover, genome of SH-Kp152234 showed to be a linear double-stranded DNA of 40578 bp with the GC content of 52.85%. It was predicted to have 49 open reading frames with related known functions.Conclusion · SH-Kp152234, with a broad host range and a short latent period, which could exert its activity in a wide range of temperature and pH, is a promising candidate to be exploited in the treatment of multiple drug-resistant Klebsiella pneumonia.

Schizophrenia is a kind of neurodevelopmental brain disease with genetic background.Cognitive impairment has always been concerned as the core symptom of schizophrenia, and genetic factors play an important role in the cognitive impairment process of schizophrenia.This paper intends to explore the relationship between various neurotransmitter systems and neurodevelopmental related genes and cognitive impairment in schizophrenia. With " schizophrenia" " cognitive" and " genetic" " dopamine" " glutamate" " serotonin" " norepinephrine" " acetylcholine" " neurodevelopmental" " genome-wide association studies" as key words, the author searched the English and Chinese literatures published from January 2001 to October 2019 in several databases, such as Pubmed, ScienceDirect, CNKI academic journal database, Wanfang academic journal database, and selected the literature that was in line with the review topic after a large number of readings.Meanwhile, the author applied the literature tracing method to search the references of the literature that had been reviewed. Finally, 29 related literatures were included, and it was found that cognitive impairment in schizophrenia is related to multiple neurotransmitter system genes and neurodevelopmental genes, and these genes have different mechanisms of action in the process of cognitive impairment. The occurrence and development of cognitive impairment in schizophrenia involve multiple gene effects. The genetic study of neurotransmitter system and neurodevelopmental level is helpful to explore the pathological mechanism of cognitive impairment in schizophrenia.Future research should focus on how the pathogenesis/candidate genes of schizophrenia affect the neurotransmitter system and neurodevelopmental circuits, and further elucidate the mechanism of genetic factors in the development of cognitive impairment in schizophrenia.

Objective This study aimed to investigate the effect and mechanism of Liraglutide on high glucose-induced vascular endothelial cell injury.Methods Human umbilical vein endothelial cells(HUVECs)were cultured and divided into 4 groups:control,high glucose stimulation(HG),Liraglutide,and Liraglutide+HG group.ELISA was used to detect the secretion of inflammatory cytokines in each group,kits the levels of intracellu-lar reactive oxygen species(ROS),the activity of SOD2 and Gpx4,and the level of MDA,and Western blot and immun of luorescence method nuclear translocation of Nrf2.Results The HG groupexhibited a significantly higher levels of tumor necrosis factor(TNF-α),interleukin(IL-1),IL-6,as well as the levels of intracellular ROS and MDA,but less activity of SOD2 and Gpx4,less contents of NO,and less nuclear translocation of Nrf2,as com-pared with the control group.Compared with the HG group,the Liraglutide+HG grouppresented significantly higher levels of TNF-α,IL-1,and IL-6,but lower levels of intracellular ROS and MDA,less activities of SOD2 and Gpx4,less contents of NO and less nuclear translocation of Nrf2.Conclusion Liraglutide suppresses high glucose-induced endothelial cell injury by increasing the nuclear translocation of Nrf2.

Objective:To investigate the effects of navigation bronchoscopy and artificial intelligence in the standardized training of residents on basic bronchoscopy skills, with the goal of enhancing their practical abilities.Methods:We selected 26 trainees (14 on standardized training of residents and 12 on standardized training of specialists) who participated in the basic navigational bronchoscopy skills and technique training (NBSTAT) at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2023 to January 2024. The training was structured around a modular curriculum with navigation as the core design concept, consisting of five modules: lesion identification, precise localization, route planning, navigation operation, and real-time error correction. Theoretical teaching and skill practice were combined. The skill proficiency of the trainees was assessed using the Ruijin Hospital bronchoscopy simulation training system and the electromagnetic navigation bronchoscopy system. SPSS 26.0 was used to perform the t-test and Wilcoxon rank-sum test for comparisons. Results:After the training, the trainees as a whole showed significant improvements in practicing the skills, with the simulated operation time was reduced from (125.08±48.16) seconds to (77.69±24.75) seconds, the number of errors decreased from 1 to 0, the total score increased from (60.77±15.01) to (75.19±17.63), and the navigation operation time was reduced from 3 (3, 4) minutes to 2 (2, 3) minutes (all P<0.05). There were no significant differences in these assessment items between resident trainees and specialist trainees. The satisfaction rate of the trainees with the training reached 100.00%. Conclusions:The curriculum is effective in basic bronchoscopy skill training, remarkably enhancing the bronchoscopy skills of resident and specialist physicians, which is a useful approach for physicians to cope with the continuous development of diagnostic and therapeutic techniques for pulmonary diseases.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

OBJECTIVE:To establish a method for the determination of related substances in Cabazitaxel injection. METHODS:HPLC method was used. The determination was performed on Agilent Eclipse XDB-C18column with mobile phase consisted of water-acetonitrile-ethanol(gradient elution)at the flow rate of 1.0 mL/min. The column temperature was 35 ℃,and the detection wavelength was set at 230 nm. The sample size was 20 μ L. Established method was used to determine related substances in 3 batches of Cabazitaxel injection. RESULTS:The linear relationship of cabazitaxel were 0.039-11.60 μ g/mL(r=0.999 8,n=7). The detection limit was 2×10-4μg,and quantitation limit was 8×10-4μg. RSD of precision and reproducibility tests were all lower than 10.0%(n=6). The amount of single impurity in 3 batches of samples ranged 0.07%-0.08%,and total amount of impurities were 0.26%-0.29%. CONCLUSIONS:Established method is simple,accurate and reliable,can be used for the determination of related substances in Cabazitaxel injection.