Objective:To re-explore and confirm the construct of the Adolescent Self-rating Life Events Checklist (ASLEC),and evaluation the reliability of it among middle school students. Methods:Totally 10 566 ad-olescents,grade 7th to grade 12th,from 10 cities were recruited to complete ASLEC by using stratified randomized cluster-sampling method. The Center for Epidemiological Studies Depression Scale (CES-D ),Multidimensional Anxiety Scale for Children (MASC)were selected as the criterion measurements which to examine the association between depression and anxiety with life events. Test-retest reliability were examined by 141 participants random se-lected after 4 weeks. Results:ASLEC including being punished,loss,relationship pressure,learning pressure and a-daption problem after explored factor analysis. The fit indices of confirmatory factor analysis were RMSEA=0. 10, CFI=0. 90,TLI=0. 88,WRMR=4. 96. The correlation coefficients of total scale with ASLEC and total score with CES-D and MASC were 0. 45 and 0. 43. The Cronbach'sαcoefficient of the total scale was 0. 92,the test-retest re-liability was 0. 73,the split-half reliability was 0. 85. The total score decreased apparently compared with the norm of Liu's study (in 1997). Compared to girls,there were significant higher score on punishment and adaption sub-scale,and significant lower score on relationship and learning pressure subscale among boys except the loss factor. Conclusion:A more reasonable new construct consists of 5 factors has been confirmed. The ASLEC has good validity and reliability. The score on total scale and subscales in this study can serve as norm references.

Objective To observe the influence of exterior-interior meridian acupoint selection on hippocampal cell apoptosis and c-Jun N-terminal kinase ( JNK) in ischemia-reperfusion injury rats, and to explore the possible protective mechanism for ischemia-reperfusion injury. Methods One hundred and twenty SD rats were randomly divided into sham-operation group (SH), model group (I/R), electroacupuncture (EA) group and JNK inhibitor SP600125 ( SP) group. The ischemia-reperfusion model was established by occlusion of middle cerebral artery with intraluminal thread. EA group was given EA on acupoints of Zusanli ( ST 36) , Sanyinjiao ( SP 6) , Chize ( LU 5) , Hegu ( LI 4) , once a day, based on the method of exterior-interior meridian acupoint selection. We observed the neurological behavioral changes by Longa neurological function standard, detected the activation of phosphorylated JNK ( p-JNK) by immunohistochemical method and examined the hippocampal apoptotic index by TUNEL method. Results The neurologic impairment scores of EA group and SP group were lower than I/R group (P<0.05) . Apoptotic index of I/R group was higher than SH group (P<0.01) and that of EA group and SP group was lower than I/R group (P <0.05) . The level of p-JNK in I/R group was higher than SH group ( P <0.01) and that of EA group and SP group was lower than I/R group ( P <0.05). Conclusion Exterior-interior meridian acupoint selection therapy has certain effect on alleviating neurologic impairment and reducing apoptosis in ischemia- reperfusion injury rats, and the mechanism might be associated with the inhibition of the activation of JNK signaling pathway.

Objective To conduct in‐depth job analysis and needs assessment on advanced midwifery practitioner (AMP) set up at a tertiary hospital .Methods The appraisal structure was designed by the needs assessment framework .Information on AMP′s job needs was collected via in‐depth interviews ,field notes and midwives′diaries .Colaizzi analysis method was used to sort out and analyze all the data .Results Seven themes through AMP′s job needs assessment were presented in the form of6W1H ,including :(1) who was AMP ;(2) whom did AMP serve;(3) what was AMP′s job content ;(4) what scope did AMP work in ;(5) how was the AMP′s practice model ;(6) where was the practical site;(7) why was the job post launched .Conclusions AMP practice at current stage is in its embryonic form of exploration but with huge potential demand ,which still needs to be improved using the needs assessment framework so that a scientific and standard job description can be formed to guide the AMP clinical practice .

Objective To investigate the diagnostic value of preoperative real-time three-dimensional color Doppler transthoracic echocardiography on assessment of patients with structural heart disease (SHD). Methods A total of 111 pa?tients were assessed preoperatively using real-time three-dimensional color Doppler transthoracic echocardiography (RT-3D-CDTTE), which include 31 SHD patients and 80 patients without SHD that were designed as negative control. Conven?tional two-dimensional color Doppler transthoracic echocardiography (2D-CDTTE) were used to compared with RT-3D-CDTTE while cardiovascular angiography and intraoperative findings were used as“Golden Standard”simultaneously. First of all, preoperative echocardiographic examination were performed and diagnosis was given. Angiography and intraoperative findings were hired to verify the accuracy of echocardiographic diagnosis before operation. Results (1) The preoperative RT-3D-CDTTE displayed three-dimensional structure and hemodynamic status of SHD cardiac lesions clearly, which were consistent with cardiovascular angiography and intraoperative findings. (2) P value of McNemar test between 2D-CDTTE and“Golden Standard”was greater than 0.05, Kappa=0.654 (P<0.001). P value of McNemar test between RT-3D-CDTTE and“Golden Standard”was greater than 0.05, Kappa=0.932 (P<0.001). Conclusion RT-3D-CDTTE can provides essen?tial information for preoperative evaluation which is important for decision of SHD management.

OBJECTIVETo provide basis for effects of an early psychological intervention on parents of children with cleft lip/palate, and investigate the effects of an early psychological intervention to them.

METHODSOne self-administered questionnaire (SCL-90) was applied in 102 parents of children with cleft lip/palate, compared to 126 parents of healthy individuals on the day of admission. They were given the psychological intervention during hospitalization and 3 months after discharge. The questionnaire (SCL-90) was again applied to them on the day of discharge and 3 months after discharge.

RESULTSUsing the questionnaire (SCL-90), the answer scores of somatization, obsessive-compulsive, depression and anxiety etc. were significantly higher than those of the control group (P < 0.05). There were no statistical differences during 3 subgroups in the case group (P > 0.05). There were no statistical differences on the day of admission and on the day of discharge (P > 0.05), but there were statistical difference on the day of admission and 3 months after discharge (P < 0.05).

CONCLUSIONIn this study, the psychosomatic states of parents of children with cleft lip/palate is poor. It's important and greatly significant that we conduct early psychological intervention to parents of children with cleft lip/palate and to the children's psychosomatic health.

Objective To evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.Methods A total of 1 200 parturients with a single baby who were at full term with a singleton fetus,aged 22-34 yr,weighing 60-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,volunteered for epidural labor analgesia for pain relief,were enrolled in the study.Epidural labor analgesia (patient-controlled epidural analgesia) was performed when uterine contraction was regular and cervical dilatation was 2-3 cm.Patient-controlled epidural analgesia solution contained the mixture of 0.1％ ropivacaine and fentanyl 2 μg/ml with a background infusion 9 ml/h,bolus dose 4 ml,lockout interval 15 min.The variation of labor analgesia was defined as the difference between the highest visual analog scale score during labor and the visual analog scale score at 30 min after epidural injection of the initial dose of local anesthetic.The receiver operating characteristic curve was used to evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.The optimal cut-off value was determined according to the maximum Youden index.Results The area under the receiver operating characteristic curve of variation of epidural labor analgesia in predicting cesarean section was 0.795,and the maximum Youden index was 53.6％,the sensitivity 87.5％ and the specificity 66.1％ when the cut-off value was 3.Conclusion Variation of epidural labor analgesia produces better accuracy in predicting cesarean section.

BACKGROUND: Intra-articular injection is a classic strategy for the treatment of early osteoarthritis (OA). However, the local delivery of traditional therapeutic agents has limited benefits for alleviating OA. Exosomes, an important type of extracellular nanovesicle, show great potential for suppressing cartilage destruction in OA to replace drugs and stem cellbased administration. METHODS: In this study, we developed a thermosensitive, injectable hydrogel by in situ crosslinking of Pluronic F-127 and hyaluronic acid, which can be used as a slow-release carrier to durably retain primary chondrocyte-derived exosomes at damaged cartilage sites to effectively magnify their reparative effect. RESULTS: It was found that the hydrogel can sustainedly release exosomes, positively regulate chondrocytes on the proliferation, migration and differentiation, as well as efficiently induce polarization of M1 to M2 macrophages. Intraarticular injection of this exosomes-incorporated hydrogel significantly prevented cartilage destruction by promoting cartilage matrix formation. This strategy also displayed a regenerative immune phenotype characterized by a higher infiltration of CD163+ regenerative M2 macrophages over CD86+ M1 macrophages in synovial and chondral tissue, with a concomitant reduction in pro-inflammatory cytokines (TNF-a, IL-1b, and IL-6) and increase in anti-inflammatory cytokine (IL-10) in synovial fluid. CONCLUSION Our results demonstrated that local sustained-release primary chondrocyte-derived exosomes may relieve OA by promoting the phenotypic transformation of macrophages from M1 to M2, which suggesting a great potential for the application in OA.

Objective:To investigate the molecular mechanism of the disease based on the clinical characterization and genetic mutation analysis in a family with intellectual disability.Methods:The proband with intellectual disability was diagnosed at Luohe Central Hospital in December 2019. Peripheral blood samples were collected from four family members. Whole exome sequencing (WES) was used to screen the pathological mutations. Then the PCR and Sanger sequencing were used to verify the selected mutations and combine the relevant database to analyze variation loci.Results:We infer that the ARX c.1162 A>G was co-segregated with the phenotype of the family based on the results of WES. The results of sanger sequencing and WES are consistent. The mother of the proband is the carrier of the mutation. There is no mutation frequency reported in the healthy population. The mutation of the ARX c.1162A>G is harmful inferred by a variety of bioinformatics software. Combined with the phenotypic analysis of OMIM database, we infer the phenotype caused by the mutation is consistent with the patients in the family.Conclusion:The mutation of the ARX c.1162 A>G may be the cause of the intellectual disability in the family affected. And the variant has not been reported in China.

Objective: To investigate the associations between early life exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ) and the risk of autism spectrum disorder (ASD) among school aged children. Methods: A total of 165 children with ASD and 165 age and gender matched typical development (TD) children were recruited. Children s basic information were obtained via questionnaires, and the severity of ASD symptoms was assessed with Social Responsiveness Scale (SRS). Early life PM 2.5 exposure (preconception, entire pregnancy, and the first two years after birth) were extracted from the Tracking Air Pollution in China (TAP) datasets. Conditional Logistic regression and generalized linear model were used to evaluate the associations of early life exposure to PM 2.5 with the risk and the ASD severity symptoms, respectively. Results: The PM 2.5 exposure of ASD group during preconception[(55.08±9.34)μg/m 3], entire pregnancy[(50.44±8.71)μg/m 3], the first year after birth [(45.04± 8.25 )μg/m 3] and the second year after birth [(40.19±7.12)μg/m 3] were significant higher than those in TD children [(47.66± 7.63 , 44.19±7.16, 38.95±6.07, 35.76±5.65)μg/m 3]( t =7.94, 7.13, 7.70, 6.32, P <0.05). After adjusting for potential confounding, each increase of 1 μg/m 3 in PM 2.5 was associated with higher risk of ASD during preconception ( OR=1.21, 95%CI =1.13-1.29), entire pregnancy( OR=1.18, 95%CI =1.11-1.26), the first year after birth ( OR=1.30, 95%CI =1.18-1.43) and the second year after birth ( OR=1.29, 95%CI =1.17-1.42). No similar results were observed regarding the analyses of SRS total and sub scale scores( P >0.05). Conclusion Early life exposure to PM 2.5 is relate to the risk of ASD, these findings indicated that more attention should be paid to ambient PM pollution in the early life prevention and control of ASD.

Objective: To investigate the association between parenting style and sleep problems among school aged children with autism spectrum disorder (ASD). Methods: A total of 98 children with ASD aged 6-10 years old and 98 age and gender matched typically developing (TD) children from mainstream schools were recruited. Parenting style and sleep problems were measured via Parent Behavior Inventory (PBI) and Children s Sleep Habits Questionnaire(CSHQ), respectively. The symptom severity and intelligence level were also evaluated. Generalized linear model was used to analyze the relationship between parenting style and sleep problems. Results: There was no statistically significant difference in the parenting style of the two groups of children( P > 0.05 ); weekend sleep time of children with ASD was significantly shorter than that of the TD group [(9.1±0.7)(9.5±0.8)h, P < 0.01 ], and the score of sleep onset delay was significantly higher than that of the TD group[(1.8±0.7)(1.5±0.7), P <0.01]. However, there was no statistically significant difference in the incidence of total sleep problems and various problems between the two groups of children( P >0.05). The parental support/engagement of children with ASD was negatively associated with the total score of sleep problems( β=-2.68, 95%CI =-4.88--0.47), bedtime resistance ( β=-1.65, 95%CI =-2.54--0.77) and sleep anxiety( β=-1.01, 95%CI =-1.70--0.32). The parental hostility/coercion was positively correlated with score of daytime sleepiness( β=1.41, 95%CI =0.53-2.29)( P <0.05). Conclusion Parenting style of support/engagement is associated with lower sleep problems in children with ASD, while hostile/coercion is associated with higher sleep problems. It should be improve parental style to reduce the sleep problems in children with ASD.