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.

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 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.

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 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 explore the effect of Internet + technical liaison service mode on the postoperative continuing nursing of elderly patients with osteoporotic hip fractures.Methods:A total of 92 elderly patients with osteoporotic hip fractures who were admitted into in Orthopaedics Department of the First Affiliated Hospital of Soochow University from July 2018 to December 2019 were selected, and randomly divided into intervention group and control group by random number table method, with 46 cases in each group. The control group was given routine follow-up outside hospital, while the intervention group was given the continuing nursing led by the orthopedic specialist nurses based on the Internet + Technology home orthopedic care platform. All patients were followed up to 6 months after operation, and the differences of Harris Hip Score (Harris), Numeric Rating Scales (NRS), Barthel Index, Short Form 36-item Health Survey (SF-36) between the two groups were compared.Results:The Harris scores were 49.74 ± 4.28, 76.59 ± 4.33 and 90.78 ± 2.61 in the intervention group, and 46.17 ± 3.85, 74.26 ± 4.24 and 88.65 ± 2.17 in the control group in 1, 3 and 6 months after operation, respectively. The differences were statistically significant ( t=-4.20, -2.60, -4.26, all P<0.05). The NRS scores in the intervention group were 1.33 ± 0.47, 0.83 ± 0.38 and 0.76±0.43 in 1, 3 and 6 months after operation respectively, while the NRS scores in the control group were 1.61 ± 0.54, 0.96 ± 0.42 and 0.84 ± 0.38, respectively. The difference in pain scores between the two groups was statistically significant only at 1 month after operation ( t=2.68, P<0.05). The Barthel Index in the intervention group were 61.74 ± 8.90, 93.80 ± 5.29 and 98.26 ± 2.83 in 1, 3 and 6 months after operation respectively, while those of the control group were 60.33 ± 5.81, 91.09 ± 7.52 and 97.83 ± 3.10, respectively. The difference in Barthel Index between the two groups was statistically significant only in 3 months after operation ( t=-2.00, P<0.05). The scores of SF-36 in the intervention group were 93.73 ± 3.89, 100.26 ± 3.77 and 107.50 ± 3.56 at 1, 3 and 6 months after operation respectively, while those of the control group were 92.67±3.42, 97.71±2.67 and 103.68±2.83, respectively. The difference in SF-36 scores between the two groups was statistically significant only at 3 and 6 months after operation ( t=-3.74, -5.71, P<0.05). Conclusions:The continuing nursing based on multi-disciplinary team cooperation in hospital + Internet + Technology home orthopaedic nursing platform led by orthopaedic specialist nurses can improve joint function, relieve pain and improve quality of life of elderly patients with osteoporotic hip fractures after operation.

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.

OBJECTIVETo explore the influence of genetic and environmental factors on the executive function of twin children.

METHODSThe executive function of 122 twin pairs from Chongqing (aged from 6 to 18 years) were investigated with the perseverative errors of the Wisconsin Card Sorting Test. Structural equation modeling was performed to evaluate the effects of the additive genetic factors (A), dominance genetic latent factors (D) and individual specific environmental factors (E) on the executive functions.

RESULTSThe effects of D and E on perseverative errors were 0. 77 (95%CI: 0.65-0.84) and 0.23 (95%CI: 0.16-0.35), respectively. The probability of perseverative errors showed a significant negative correlation with family functioning and with the total GHQ-12 scores of the fathers and mothers (r:-0.335, -0.335, and -0.219, respectively, P<0.01). Perseverative errors were not significantly correlated with the parenting styles and stress life events.

CONCLUSIONPerseverative errors are influenced by a common dominance genetic latent factor and individual specific environmental factors, but the role of environmental factors such as family functioning and parental health can not be ignored.

Objective:To analyze the mutations in desmosomal protein genes of arrhythmogenic right ventricular cardiomyopathy (ARVC) in relatives of Yunnan unexplained sudden death (YUSD) cases in Nanjian County, Dali Prefecture, Yunnan Province, and provide a basis for etiological hypothesis and control measures.Methods:The blood samples of YUSD case relatives ( n = 7) and control villagers ( n = 7) were collected, and basic situation investigation and electrocardiography (ECG) examination were performed at the same time. Blood DNA was extracted as a template for PCR amplification, and Sanger method was used to perform plakophilin 2 (PKP2), desmoglein 2 (DSG2), desmocollin 2 (DSC2), desmoplakin (DSP), and junction plakoglobin (JUP) five ARVC desmosomal protein genes sequencing of a total of 97 exons, and comprehensive analysis of gene mutations was carried out. Results:Five of YUSD case relatives carried genetic mutation sites, including DSP gene heterozygous synonymous mutations about exon 20 c.2862 C>T (p.Cys954Cys) and exon 24F c.7122 C>T (p.Thr2374Thr), DSC2 gene heterozygous missense mutation about exon 15 c.2326 A>G (p.Ile776Val), and all the five people were single heterozygous mutation carriers. Among them, two case relatives of the father-son carried the same site mutation of the DSC2 gene; the abnormal ECGs of three YUSD case relatives were ST-T change or clockwise rotation. However, the mutation sites of PKP2, DSG2, DSC2, DSP and JUP genes in control villagers were not detected.Conclusions:YUSD case relatives in Nanjian County carry ARVC desmosomal protein genes DSP and DSC2 mutations. Pathogenic mutation of DSC2 gene c.2326 A>G (p.Ile776Val) is may related to the incidence of some YUSD cases.