Neurosteroids exist in central and peripheral nervous system, independence of peripheral glands, including pregnenolone, progesterone, allopregnanolone, and dehydroepiandrosterone, etc. They can be synthesized in the nervous system from sterol or sterol precursors catalyzed by certain enzymes. They play roles by interacting with GABAA, NMDA or?receptors, and have effects on memory, sleep, convulsion, cellular excitability, etc.

Objective To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method:McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.

Objective To examine the therapeutic effect of C Ⅱ TA inhibition in collagen-induced arthritis(CIA),using a delivery system tailored to target C ⅡTA gene by small interfering RNA (siRNA).Methods Mice with collagen-induced arthritis were injected intravenously with C Ⅱ TA siRNA.The clinical score was monitored for up to 4 weeks after treatment.The severity of inflammation of mouse joint was evaluated by histological examination.Real-time PCR was used to determine the cytokine mRNA expression.Cytokine production was measured by ELISA from serum.T cell proliferation was examined by MTT method.Results IFN-γ and IL-17 were elevated in CIA mice,but were iuhibited significantly by C Ⅱ TA siRNA either prevention or intervention of autoimmune arthritis.Collagen specific T cell proliferation was significantly suppressed.Increased level of IL-4 by T cells was observed in C Ⅱ TA siRNA treated group compared with that of control group.Conclusion Our findings indicate that systemic RNAi-mediated C Ⅱ TA gene silencing is effective in the treatment of CIA and regulateds the balance of Th1/Th2 differentiation.

For medical student, diagnostic practice is the first step of clinical study. To penetrate the humanities education in diagnostic teaching,the combination with practice from the following steps as physical examination, laboratory examination and interrogation, would cultivate medical students' humane quality imperceptibly and play an important role in creating noble medical ethics of them.

Objective Using twins methods to explore the influence of genetic and environmental factor on Intelligence develop-ment of children and adolescent twins .Methods It was 190 pair of twins aged 6 to 18 who lived in Chongqing were recruited ,DNA were extracted from buccal mucosa and venous blood samples to identify zygosity .The intelligence was investigated by using the Wechsler Intelligence Scale for Children(C-WISC) ,the intrapair correlation coefficients of twins were compared and calculate the genetic degrees .Results The total IQ of children aged 6 to 18 heritability were 0 .63 ,Verbal IQ were 0 .44 ,Performance IQ were 0 .57 .The total IQ heritability of children aged 10 to 14 and 15 to 18 years(0 .78 ,0 .79) were higher than that of those aged from 6 to 9 years(0 .018) .Conclusion This study suggested the intelligence of children aged 6 to 18 affected by genetic and environment , and the older ,the more influence of genetic on intelligence development .

Objective To evaluate the risk factors of delirium in patients of intensive care unit ( ICU) by different scale systems.Methods Totals of 440 patients were enrolled in this investigation.Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Intensive Care Delirium Screening Checklist ( ICDSC) were used when patients in-and out-ICU.Other risk factors and APACHE Ⅱ score were recorded. Multiple linear regression was done between each scale and all risk factors.Results The scores of APACHEⅡ, SAS,SDS and ICDSC were (9.8 ±3.2), (43.8 ±11.3), (43.1 ±10.8) and (2.43 ±2.00) when patients discharged from ICU.Those values were (17.3 ±5.5), (48.3 ±12.7), (48.5 ±12.3) and (1.36 ±0.81) when patients first admitted to ICU.There were significant differences ( t =7.549,3.004,3.780,-3.329, respectively;P<0.05).Multiple linear regression analysis showed that the score of SAS was correlated with duration in ICU, APACHEⅡscore and drainage catheter amount (R2 =0.515,F=14.139,P<0.001).The score of SDS was correlated with duration in ICU and drainage catheter amount ( R2 =0.444,F=16.395,P<0.001) .The score of ICDSC was correlated with education, duration in ICU, duration of mechanical ventilation and APACHEⅡscore (R2 =0.803,F=39.769,P<0.001).Conclusions The sensitivity of ICDSC is high and can be used to screen delirium in ICU.The incidence of delirium increases with the duration of ICU stays.

Objective To evaluate the effect of of home-care orthopedic nursing platform in rehabilitation exercise of patients after knee replacement.Methods A total of 60 patients with knee joint replacement were randomly divided into experimental group (n =30) and control group (n =30).The control group adopted conventional nursing,while the experimental group was added home care platform for orthopedics.Joint function recovery (HSS score),quality of life score (SF-36) and daily living ability (Barthel index) between the two groups were compared on admission,and at 6 months after discharge.Results No statistical differences in culture and knowledge absorption and understanding ability were found between the two groups before intervention (P ＞ 0.05).After intervention,the score of knee function,quality of life and ability of daily living of the patients in the experimental group were significantly higher than that in the control group (P ＜ 0.01).Conclusion Home care platform of orthopedics provides a new extension nursing mode for patients after total knee arthroplasty.It is a scientific and reliable rehabilitation consultation platform,which significantly improves postoperative rehabilitation and quality of life.

Objective To evaluate the effect of of home-care orthopedic nursing platform in rehabilitation exercise of patients after knee replacement.Methods A total of 60 patients with knee joint replacement were randomly divided into experimental group (n =30) and control group (n =30).The control group adopted conventional nursing,while the experimental group was added home care platform for orthopedics.Joint function recovery (HSS score),quality of life score (SF-36) and daily living ability (Barthel index) between the two groups were compared on admission,and at 6 months after discharge.Results No statistical differences in culture and knowledge absorption and understanding ability were found between the two groups before intervention (P ＞ 0.05).After intervention,the score of knee function,quality of life and ability of daily living of the patients in the experimental group were significantly higher than that in the control group (P ＜ 0.01).Conclusion Home care platform of orthopedics provides a new extension nursing mode for patients after total knee arthroplasty.It is a scientific and reliable rehabilitation consultation platform,which significantly improves postoperative rehabilitation and quality of life.

Objective To explore the influence of genetic and environmental factors on emotional and behavioral problems in children and adolescents using twins quantitative method. Methods One hundred fifty-six twins pairs, aged from 6 to 18, were included in the present study. The parental version of the strengths and difficulties questionnaire (SDQ)was used to evaluate their emotional and behavioral problems. The DNA test of twin zygosity was conducted using DNA extracted from buccal mucosa or venous blood samples. The influence of genetic and environmental factors on emo-tional and behavioral problems was analyzed using structural equation modeling(SEM). Results Shared environment and special environment had impact on emotional symptoms and their contribution to the total variance of emotional symp- tom was 0.42 and 0.58, respectively. Prosocial behavior was mainly affected by shared environment and the contribution of shared environment to the total variance of prosocial behavior was 0.89. Genetic factors had greater influence on hyperac-tivity/attention deficit and the contribution of genetic factors to the total variance was 0.62. Shared environment had more influence on conduct disorder and the contribution of shared environment to total variance was 0.56. Heredity, shared envi-ronment and special environment had impact on peer problems and their contribution to the total variance was 0.24, 0.33 and 0.43, respectively. Conclusion In child and adolescent period, emotional symptoms are only affected by environ-ment, while behavior problems are affected by the combination of heredity and environment. Different behavior problems are affected by different genetic and environmental factors.

Objective:To evaluate the sleep disorders in patients with Parkinson′s disease (PD) with different onset sides, and to analyze the correlation between PD kinesia-onset side and sleep disorders.Methods:A total of 658 patients with primary PD admitted to the Special Outpatient Department of Parkinson′s disease in Fujian Medical University Union Hospital from January 2015 to March 2021 were collected. According to the onset side of motor symptoms, they were divided into the left group (313 cases) and the right group (345 cases). The medical history collection and physical examination were conducted to evaluate the motor symptoms, non-motor symptoms [Non-Motor Symptom Scale (NMSS)], depression state and cognitive function of the patients. Parkinson′s Disease Sleep Sclale-2 (PDSS-2) and the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ) were used to evaluate and analyze their sleep status, and comparisons were made between groups. Binary multivariate Logistic regression analysis was used to access the risk factors associated with sleep disorders in Parkinson′s disease.Results:The scores of daytime fatigue [2.00(0, 4.00)] and unexplained limb pain [4.00(0, 4.00)] in NMSS assessment of PD patients in the left onset group were significantly higher than those in the right onset group [1.00(0, 3.00), Z=-2.545, P=0.001; 2.00(0, 4.00), Z=-2.797, P=0.005]. There was no significant difference in the total score of PDSS-2 between the two groups, but there were significant differences in limb restlessness, periodic limb activity, muscle spasm and early drowsiness between the two groups. In the evaluation of rapid eye movement sleep behavior disorder (RBD), the total score of RBDSQ in the left onset group [2.00(0, 4.00)] was significantly higher than that in the right onset group [1.00(0, 3.00), Z=-4.363, P<0.001]. The incidence of dream content, nocturnal behavior, nocturnal exercise, self-injury and bed partner in dream, abnormal behavior at night, nighttime awakening, dream memory and sleep disorder in the left onset group was also higher than that in the right onset group. In addition, binary multivariate Logistic regression showed that PD-related sleep disorders were associated with onset of advanced age ( OR=1.037, 95% CI 1.018-1.057, P<0.001), course of disease ( OR=1.014, 95% CI 1.010-1.018, P<0.001) and onset of abnormal postural gait ( OR=1.505,95% CI 1.058-2.141, P=0.023). RBD in patients with PD was associated with left onset ( OR=2.215,95% CI 1.395-3.515, P=0.001), advanced age onset ( OR=1.045,95% CI 1.019-1.072, P=0.001) and course of disease ( OR=1.014,95% CI 1.009-1.019, P<0.001). Conclusions:PD patients with left onset are more likely to have sleep disorders such as limb restlessness, periodic limb activity, muscle spasm and early drowsiness. At the same time, the incidence and severity of RBD in patients with left onset of PD are significantly higher than those of patients with right onset of PD. The onset side of motor symptoms of PD is an important factor affecting sleep disorders, and the onset of left side may be a risk factor for PD patients with RBD.