OBJECTIVE: To analyze the effects of social and psychological factors on rehabilitation status of end stage renal disease (ESRD) patients under peritoneal dialysis. METHODS: From August in 2005 to March in 2007, 171 patients experienced peritoneal dialysis were diagnosed at the Center of Peritoneal Dialysis, Department of Nephrology, First Hospital, Peking University, including 66 males and 105 females, aged (60±13) years, with an average dialysis time of 22.8 months. They were studied with questionnaires and interview. Rehabilitation status was investigated from two aspects of activity and participation by Karnofsky activity index, Social Dysfunction Screening Scale. Hamilton depression and anxiety scales, Medical Coping Modes Questionnaire and Social Supporting Rating Scale were used to investigate social and psychological factors.RESULTS: A total of 200 questionnaires were handed out and 171 (85.5%) of them were drawn in. 134 patient had normal activity status, 78.4% of them had Dysfunction and 129 patients (75.4%) had normal social function status. Forty-two (24.5%) of patients had the symptom of anxiety, 15 (8.2%) had depression. The score of "Acceptance-Resignation" was significantly higher in this group than patients with other chronic diseases. There were no significant differences in scores of "Confrontation" and "Avoidance". Activity of rehabilitation outcome and participation index served as dependent variable, whereas depression and anxiety, coping mode and social supporting as independent variable. Using multiple stepwise regression analysis, factors that affected patient rehabilitation were found, including depression, utilization of social support and the facing coping mode. CONCLUSION: Depression, utilization of social support and the facing coping mode have important effects on patient rehabilitation.

Objective To statistically analyze data of blood transfusion from General Hospital of Chengdu Military Command,Mianyang field blood station,Deyang field blood station and other military medical institutions from May 12 to June 30,2008 so as to provided certain references for reasonable blood supportability in wartime and disaster.Methods A statistical analysis was done on data of blood collection and supply including self-taken blood and assembled blood,total amount of blood supply as well as the transfusion information of inpatients injured by earthquake in our hospital.Results The amount of self-taken blood was 5 111 U,the amount of assembled blood 3 380 U and the total amount of blood supply 1 0405.5 U.But blood transfusion was 4 090.6 U in 132 patients admitted into General Hospital of Chengdu Military Command.In addition,the crest-time of transfusion appeared at 96 hours after earthquake.Moreover,patients with fractures received the highest rate of blood transfusion and crush syndrome patients received the most blood transfusion and the highest per capita transfusion.Conclusions Blood supportability in earthquake is different from that in wartime and other disasters in aspects of transfusion time,blood types and blood transfusion volume.It is important to analyze the characteristics of transfusion in patients injured by earthquake for national strategy of blood supportability in disasters and for blood supportability in the wartime.

Objective To explore the etiologies of persistent hyperbilirubinemia in follow-up patients after liver transplantation. Methods The clinical data of 527 follow-up patients after liver transplantation at the department of hepatobiliary surgery in Peking University People's Hospital between May 2000 and Dec 2009 were analyzed retrospectively. Results Sixty-five patients experienced persistent hyperbilirubinemia,there were 34 cases of biliary complications (52.3％ ),14 cases with drug-induced liver injury(21.5％ ),6 cases with hepatitis B or C recurrence(9.2％ ),4 cases with acute rejection (6.2％ ) 3 cases with inflammatory stenosis of the duodenal papilla ( 4.6％ ),2 cases with hepatic carcinoma recurrence(3.1％ ),1 case with neomalignancy and 1 case with unknown reason.Treatment included use of liver protectant and choleretics,the adjustment and replacement of anti-rejection drugs,cholelithotomy by choledochoscope,PTCD,placement of biliary stent and re-operation.Of all the 65 cases 50 patients were cured or in stable condition,15 patients died. Conclusions Jaundice is a common clinical manifestation after liver transplantation with multiple and complicated causes.Diffuse stricture of intrahepatic biliary tract predicts poor prognosis,drug-related liver injury was less common cause of hyperbilirubinemia and often misdiagnosed.

Objective To analyse the risk factors of vulnerable plaque biomarker and to construct an early warning system. Methods Ninety patients with suspected acute coronary syndrome (ACS) hospitalized during December 2012 and December 2013 were selected. The coronary artery lesions were divided into type I, II and III plaque groups by the morphology of atherosclerotic plaque. Serum SAA, PLGF, sCD40L and Npt were measured. The results of SAA, PLGF, sCD40L and Npt were compared. Logistic regression model was fitted to explore the main influencing factors of the vulnerable plaque. Results SAA, PLGF, sCD40L, and Npt were main influencing factors of the vulnerable plaques, and the ORs were 1.61, 1.88, 1.96 and 1.79 respectively. Conclusion The detection of SAA, PLGF, sCD40L and Npt biochemical markers in patients with chest pain is important for predicting the vulnerable plaque and guiding clinical treatment.

Objective Subarachnoid hemorrhage ( SAH) is a devastating disease with high fatality and morbidity and micro-glia/macrophage ( M/M) plays a vital role in SAH brain injury with complicated pathophysiological mechanism .This study was to ob-serve the effect of Nrf2 deficiency on M/M activation and M1 polarization after subarachnoid hemorrhage in mice . Meth ods We col-lected 70 wild-type ( WT) ICR mice and 35 Nrf2-knockout ( KO) mice to establish the SAH model by injecting fresh autologous blood into pre-chiasmatic cistern.WT mice were arranged into four groups: sham operation group, post operative day 1 (POD1) group, POD3 group and POD5 group.Then WT mice and Nrf2 Nrf2-knockout mice were divided into sham operation WT group , sham opera-tion KO group, SAH WT group and SAH KO group.Western blotting (WB) and immunohistochemistry (IHC) were applied to observe the activation and proliferation of M/M after SAH on WT mice .Difference in activation and M 1 polarization were observed by detecting Iba1 expression in WB and CD 16/32 +Iba1 +cells in immunofluorescence between WT and KO mice . Results Gray scale values of Iba1 expression by WB in WT mice are 0.491 ±0.039, 0.657 ± 0.069, 0.930 ±0.046 and 0.926 ±0.046;average optical intensity values of Iba1 expression by IHC in WT mice are 0.412 ±0.122, 0.625 ±0.135, 0.963 ±0.213 and 0.978 ±0.224.The data indica-ted that Iba1 expression increased in SAH KO group in comparison to SAH WT group on 1, 3, 5 day after SAH (P<0.05).Moreover, Nrf2 deficiency promoted the activation and polarization of M /M by increased Iba1 protein expression and CD16/32 +Iba1 +cells after SAH ( P<0.05). Conclusion SAH induces M/M activation and proliferation in mice, and Nrf2 deficiency promotes the activa-tion, proliferation and M1 polarization after SAH .

Objective Subarachnoid hemorrhage ( SAH) is a devastating disease with a high mortality.This study was to in-vestigate the effect of Nrf2 on secondary brain injury following SAH and its action mechanism in mice. Methods SAH models were established in wild-type ( WT) and Nrf2 knockout ( KO) ICR male mice by injecting fresh blood drawn from the femoral artery into the pre-chiasmatic cistern.The animals were divided into four groups, WT sham, WT SAH, KO sham, and KO SAH.At 24 hours after modeling, the expression levels of malondialdehyde ( MDA) , GSH/GSSG, TNF-αand IL-1β, the volume of brain water, and content of Evans blue were measured, the activity scores obtained, and cerebral vasospasm of the anterior and middle cerebral arteries ( ACA and MCA) detected. Results At 24 hours, the expressions of MDA, TNF-α, and IL-1βwere (3.299 ±0.335), (1.187 ± 0.436), and (59.330 ±21.787) mg/g in the WT sham group, (4.339 ±0.328), (2.432 ±0.434), and (121.584 ±21.675) mg/g in the WT SAH group, (3.488 ±0.634), (1.170 ±0.312), and (58.497 ±15.608) mg/g in the KO sham group, and (5.335 ±0.499), (3.132 ±0.548), and (171.117 ±50.479) mg/g in the KO SAH group, markedly increased in the SAH groups as compared with the sham controls (P<0.05), while the GSH/GSSG levels were significantly higher in the former two groups than in the latter (0.553 ±0.100 and 0.375 ±0.068 vs 0.714 ±0.091, 0.761 ±0.114, P<0.01).The contents of brain water and Evans blue were (0.784 ±0.005) and (7.055 ±1.046) μg/g in the WT sham group, (0.808 ±0.004) and (7.230 ±1.192) μg/g in the WT SAH group, (0.784 ±0.004) and (9.620 ±1.290) μg/g in the KO sham group, and (0.819 ±0.004) and (11.628 ±1.040)μg/g in the KO SAH group, remarkably increased in the SAH groups in comparison with the sham groups (P<0.05).The apoptosis rate 8.916 and 82.100 ±6.870 vs 70.833 ±8.750 and 51.767 ±13.006), ACA radius/wall thickness value (13.885 ±3.360 and 14.212 ±3.2545 vs 8.024 ±2.780 and 6.861 ±2.702), MCA radius/wall thickness value (18.648 ±2.893 and 19.435 ±2.775 vs 6.337 ±3.993 and 5.107 ±3.805), and activity score (2.733 ±0.450 and 2.767 ±0.430 vs 1.967 ±0.928 and 1.433 ±0.679) (all P<0.01). Conclusion Nrf2 knockout increases oxidative stress and inflammatory reaction following SAH and consequently aggravates secondary brain injury.Nrf2 has a protective effect against SAH-induced brain injury.

Objective To study the alterations of CD19+CD5+CD1dhigh B, Th1 and Th17 cells in non-obese diabetic ( NOD) mice and the correlation between B10 cells and type 1 diabetes in NOD mice. Methods Flow cytometry ( FCM) was used to measure the levels of CD19+CD5+CD1dhigh B, CD19+IL-10+B, CD4+IFN-γ+Th1, CD4+IL-17+Th17 and CD4+CD25+Foxp3+T cells in NOD mice ( 4 weeks old NOD mice:group A, n=10;8 weeks old NOD mice:group B, n=10; NOD mice with diabetes: group C, n=10) and age-matched C57BL/6 mice ( control group, n=20 ) .Hematoxylin-eosin staining of pancreatic tissues was performed for histopathological assessment of the development of insulitis in NOD mice.Results (1) Histopathological analysis showed that mice from A, B and C groups respectively showed no insulitis, insulitis and obvious insulitis with no intact islets.(2) The highest levels of B10 cells in NOD mice were ob-served in group B, followed by those in group C and group A (P<0.01).No significant differences with the levels of B10 cells were found among different tissues of 4 weeks old NOD mice (P>0.05).More B10 cells were detected in pancreatic lymph nodes than in other tissues of 8 weeks old NOD mice, the levels of which were also higher than those in pancreatic lymph nodes of mice form group C ( P<0.01) .The highest levels of B10 cells were detected in peripheral lymph nodes among all tissues samples collected from NOD mice with diabetes (P<0.01).(3) The levels of Th1 and Th17 cells in mice from group C were remarkably in-creased as compared with those in mice from group A and B (P<0.01).(4) The percentages of CD4+CD25+Foxp3+T cells in mice from group C showed no differences with those in mice from A and B groups. No significant difference with Treg cells were observed between NOD mice and age-matched C57BL/6 mice (P>0.05).Conclusion The percentages and distribution of B10 cells in NOD mice changed with age and the development of insulitis.The decrease of B10 cells might participate in the development of type 1 diabe-tes in NOD mice.

Objective To investigate the phenotypes and percentages of B 10 cells in different tis-sues from wild-type mice and to identify their biological functions .Methods The percentages of B10 cells derived from different tissues of mice and their responses to lipopolysaccharide ( LPS) stimulation were ana-lyzed by flow cytometry .Magnetic-activated cell sorting ( MACS ) and fluorescence-activated cell sorting (FACS) were used to purify B10 cells, CD4+CD25-T cells and Treg cells.CD4+CD25-T cells and Treg cells labeled by CFSE were co-cultured with or without B10 cells, and then their proliferation were evaluated after 72 h.Results (1) A subset of CD19+CD5+CD1dhigh regulatory B cells was identified in spleen , pe-ripheral blood and lymph nodes from wild-type mice , of which the highest frequency was detected in spleen (3.95%±0.79%, P<0.05).The isolated B cells from different tissues were stimulated by LPS , PMA, ionomycin and monensin (L+PIM) in vitro to express IL-10.Among them, splenic CD19+IL-10+B cells showed the highest expression of IL-10 (P<0.05).(2) Prolonged LPS stimulation (48 h) to CD5+CD1dhigh B cells enhanced the expressions of IL-10 (P<0.01).(3) CD19+CD5+CD1dhigh B cells inhibited the prolif-eration of CD4+CD25-T cells in vitro in a dose-dependent manner (P<0.01), but increased the secretion of IL-10 by CD4+T cells (P<0.01) and the proliferation of Treg cells in vitro (P<0.01).Conclusion Com-pared with other tissues , the percentage of B10 cell subset in spleen is the highest in wild-type mouse , and B10 cells subset can be activated through Toll-like receptor ( TLR ) signaling pathway .The responses of CD4+CD25-T cells and Treg cells in co-culture with B10 cells are regulated by B 10 cell subset through an increased IL-10 production .B10 cells might be a useful cell population for the treatment of inflammatory au-toimmune diseases.

Objective:To explore the characteristics of somatic symptoms and their dynamic changes after treatment in elderly inpatients with depression,so as to give supported data in differential diagnosis and management of somatic symptoms in the elderly patients.Methods:Totally 69 consecutively hospitalized depression patients(≥60 years)were enrolled in the study,and 62 of them completed the 12-month follow-up.The diagnoses were made according to International Statistical Classification of Diseases and Related Health Problem-10th revision(ICD-10) criteria.The Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Somatic Symptom Self-rat-ing Scale-Somatic factor(SSS-S)were used to assess the severity of depression,anxiety and somatic symptoms, which were evaluated at baseline,2 weeks,4 weeks and the end of 12-monthr espectively.The Minimum Mental State Examination(MMSE)were used to evaluate cognitive function,and Global Assessment Function(GAF)were used to evaluate social function at the end of 12-month follow-up.Result:Somatic symptoms presented in the all patients at the stages of depressive episode.The most common ones were gastrointestinal symptoms(91%),dizzi-ness or headache(66%),cardiovascular symptoms(59%).SSS-S scores at 2 weeks and 4 weeks of antidepressant treatment were significantly improved compared with those of baseline,[(13.6 ±3.2),(12.4 ±2.8)vs.(17.1 ± 4.8),analyzed by repeated measures of ANOVA,P <0.05].The changes of SSS-S scores were positive associated to the changes of anxiety symptoms and the effect of physical diseases,analyzed by hierarchical linear model analy-sis.At the stages of rehabilitation,residual somatic symptoms were positive associated to the degree of anxiety symptoms(OR =2.132,P <0.05),and unrelated to the level of HAMD,MMSE and GAF scores analyzed by logis-tic regression analysis.Conclusion:Somatic symptoms are various in elderly inpatients with depression during the a-cute phase,which are improved greatly as effective antidepressant treatment,and still have residual somatic symp-toms at the stage of rehabilitation.The effect of physical diseases and anxiety symptoms have influence on somatic symptoms.

INTRODUCTION: The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families and healthcare professionals. Grief, which is the reaction to these losses, could cause strain on these individuals' physical and mental health if not identified and managed early. This scoping review analysed loss, grief and how they were managed among these groups during the pandemic. METHOD: This scoping review utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework for scoping reviews. Only qualitative studies relating to loss and grief and their management were included. Of 166 studies screened, 69 were included in the study. Qualitative analysis and data coding of each record were conducted through qualitative data analysis software. RESULTS: Losses included the death of family members, patients, colleagues and others. They also included the loss of usual routines, lifestyles and physical health. The grief experienced was multidimensional, affecting mainly the emotional, physical, social and existential realms. Anger, guilt and fear resulted from unsatisfactory farewells, issues with funerals, social isolation, financial strain and stigmatisation. Management strategies could be categorised into 5 themes: communication, finance, counselling, education and spiritual care. CONCLUSION Loss and grief identification and management among patients, family members and healthcare professionals are critically important during this COVID-19 pandemic. Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief. Nevertheless, further research is necessary to better understand the effectiveness of implemented policies.
Humans ; COVID-19 ; Grief ; Health Personnel ; Pandemics ; Qualitative Research