Objective To investigate the usage of defluoridation stove and the formation of related behavior in the disease affected areas and the current situation of coal-burning-borne endemic fluorosis,to evaluate the control effect,so as to provide a theoretical basis for superior department to adjust the control strategy in time.Methods According to The Implementation Plan for Prevention and Treatment of Coal-burning-borne Endemic Fluorosis in Shaanxi Province,Ziyang and Langao in Ankang City were chosen for epidemiological survey.Using stratified sampling method,according to the degree of disease situation,each county was divided into 3 layers and then 5％ from each layer was extracted to carry out an investigation,respectively.The number of investigated village was at least 1,up to 30.The number in a non-endemic area was 1-3.Questionnaire survey of all residents was carried out to ask of the changes of cooking and heating fuel;the correct usage of the improved stove;the changes of life behavior related to the corn and pepper for human consumption and the development of prevention and treatment of post management.In endemic areas and in non-endemic areas,according to the Determination of Fluoride in Foods (GB/T 5009.18-2003),fluoride levels of corn (or rice) and chili which collected from 10 families were determined.Meanwhile,the criteria for Diagnosis of Dental Fluorosis (WS/T 208-2011) was used to diagnose dental fluorosis and the criteria of Urine-determination of Fluoride-ion Specific Electrode Method (WS/T 89-1996) was used to evaluate urine fluoride;dental fluorosis of every child aged 8-12 was examined and 10 copies of urine samples were randomly collected in each age group.Housewives and students over the age of 16 in endemic areas were quizzed of the knowledge of health and diagnosed serious skeletal fluorosis according to The Diagnostic Criteria of Endemic Fluorosis (WS 192-2008).Results The rates of correct usage of improved furnace and oven were 91.43％ (3 019/3 302) and 95.72％ (3 578/3 738).The autonomous maintenance rate of stoves was 0.61％ (49/7 998).In endemic areas,the correct drying rate and the correct storage rate of corn and pepper were all 100.0％ (300/300);the washing rate of corn and pepper before eating was 98.3％ (7 863/7 998).The fluoride median contents of corn and pepper was 0.800 and 2.863 mg/kg,respectively.In non-endemic areas,The fluoride median contents of corn and pepper was 0.443 and 4.065 mg/kg,respectively.The awareness rates of health knowledge were 81.27％ in housewives and 90.32％ in students.Dental fluorosis detection rate of 8-12 years old children was 12.52％ (87/695);the fluoride content was between 0.04-7.00 mg/L and the geometric mean value of fluoride content was 0.61 mg/L in endemic areas.There was no new case of serious skeletal fluorosis.Conclusions The prevention effect is obvious.Disease surveillance,health education and management of defluoridation stoves are keys to prevent coal-burning-borne endemic fluorosis.

Objective To explore the effect of individualized chemotherapy plans which was designed depend on secific genetic characters in patients with advanced cancer.Methods The surgery or biopsy specimen samples from 25 patients with advanced recurrent tumors (study group) were analyzed.Different gene mRNA expressions were detected by PCR and sequencing.According to detection results,the most appropriate chemotherapy would be applied on 25 cases patients of study group.The chemotherapy from traditional experience and evidence-based medical evidence were applied for 20 cases patients of control group.The difference of RR and disease control rate (DCR) between two groups were compared.Results The DCR and RR were 84 ％ (21/25) and 44 ％ (11/25) in study group,35 ％ (7/20) and 15 ％ (3/20) in control group.The DCR and RR in study group were significantly higher than those in control group (P ＜ 0.01).Conclusion Individualized chemotherapy could improve the efficient and prolong the survival period of the patients with advanced recurrent tumors.

Abstract Deviant behaviors among adolescents is widespread and have substantial impacts on family and society. Increasing evidence has shown that adolescents who experienced traumatic stress events and suffered from post traumatic stress disorder are at significantly higher risk of deviant behaviors than their healthy peers and have their personal lives negatively affected. In this review, the effect of PTSD on deviant behaviors in adolescents is summarized, in which adolescent deviant behaviors are mainly classified into extroverted, introverted, and academic deviant behavior, as well as deviant habits. Meanwhile, aims to explore the neural mechanism linking PTSD and adolescent deviant behaviors, and to provide suggestions for intervention of deviant behaviors.

OBJECTIVE:To investigate the perioperative prophylactic use of antibiotics in thoracic surgery department of 7 hos-pitals in Nantong city,and to provide reference for rational drug use in clinic. METHODS:In retrospective study,6652 dis-charged patients with thoracic surgery were selected from 7"third-level hospitals"of Nantong city during 2015-2016. The gender, age,length of stay,preoperative medication,medication timing,classification of incision,operation time,drug name,usage and dosage,route of administration,drug combination and prognosis were analyzed statistically. According to the relevant regulations of special rectification and the principle of perioperative antibiotics use,the rationality of antibiotics use was evaluated. RE-SULTS:Among 6652 patients,there were 2761 cases of typeⅠincision and 3891 cases of typeⅡincision. All of them used anti-biotics. Primary prophylactic time was 0.5-2 h before operation in 5282 cases,accounting for 79.40％;1370 cases were given medicine more than 2 h before surgery or after surgery,accounting for 20.60％. Totally 1070 cases received prophylactic medica-tion within 48 h,accounting for 16.09％;5582 cases received prophylactic medication more than 48 h,accounting for 83.91％. A total of 5702 cases were given only one antibiotic,and 950 cases received two-drug combination. A total of 6342 patients used an-tibiotics irrationally,accounting for 95.34％. Eight categories 15 kinds of antibiotics were involved. β-lactam/β-lactamase inhibi-tors,fluoroquinolones and cephalosporins were mostly used. CONCLUSIONS:After the implementation of special rectification, there are still many irrational phenomena in the prophylactic use of antibiotics in thoracic surgery department of 7 hospitals in Nan-tong city. Some indexes exceed the national standard and still need to be further managed and improved.

Objective:To explore a new way of pharmaceutical service mode for disease treatment. Methods:Clinical pharmacists actively participated in the pharmaceutical care for a patient with mixed liver injury, and provided clinical pharmaceutical services through the adverse reaction analysis,etiological mechanisms exploration,therapeutic drugs selection and risk factors prevention. Re-sults:Clinical pharmacists cooperating closely with physicians helped to identify problems in time,and then the medication analysis in the fields of drug selection, dose determination, efficacy evaluation and indicators detection was performed, so that the strategies on medicine treatment could be adjusted timely as the disease progressed. With the gradual recovery of liver function, the patient dis-charged after the conditions were improved. Conclusion:By participating in pharmaceutical practice,clinical pharmacists can provide clinical pharmaceutical service,which is helpful to safety improvement and efficiency of drug administration. It is also an effective way to enhance the learning ability of pharmacists,and cultivate their clinical thinking and practice capacity.

Objective:To investigate the clinical features of pertussis in children and analyze the risk factors of severe pertussis.Methods:The clinical data of 248 children with pertussis hospitalized in Hunan Children′s Hospital from March 2018 to March 2022 were analyzed retrospectively.According to the age at admission, the patients were divided into two groups: ≤3 months and > 3 months.According to the patient′s condition, they were classified into ordinary group and severe group.According to the pathogens detected, the children were divided into single infection group and mixed infection group.The independent sample t-test, chi- square test were used to analyze the clinical indexes of the infants in above groups. Results:(1)Of 248 hospitalized children with pertussis, 204 cases (82.2%) were less than 1 year old, 92 cases (37.0%) had contact with a coughing family member before, and 169 cases (68.1%) were unvaccinated.Among 248 children, 193 cases (77.8%) had an elevated white blood cell count, and 145 cases (58.4%) had mixed infections.The most common pathogen was respiratory syncytial virus [29/248(11.6%)]. About 173 cases (69.7%) had concurrent pneumonia, and 35 cases (14.1%) had pulmonary consolidation.(2)Compared with the group > 3 months of age, more patients in the group ≤3 months of age had contact with a coughing family member before, and suffered from cyanosis, dyspnea, respiratory failure, heart failure and pertussis encephalopathy ( χ2=4.612, 20.810, 7.882, 16.617, 13.740, 7.846, all P<0.05). The proportions of patients in the group ≤3 months of age required intensive care unit(ICU) hospitalization and mechanical ventilation were higher than those in the group > 3 months of age ( χ2=14.810, 21.436, all P<0.05). The mortality of the group ≤3 months of age was higher than that of the group >3 months of age ( χ2=12.016, P<0.05). Children ≤3 months of age had a higher WBC level [(27.83±27.70)×10 9/L vs.(23.34±15.28)×10 9/L, t=22.244, P<0.001], longer duration of spasmodic cough [(16.56±9.33) d vs.(15.06±6.16) d, t=10.145, P=0.002] and longer hospitalization time [(11.47±10.48) d vs.(9.48±4.80) d, t=20.050, P<0.001] than those >3 months of age.(3)Compared with the ordinary group, a higher proportion of children in the severe pertussis group were under 3 months old, and had not been vaccinated against pertussis vaccine ( χ2=14.803, 4.475, all P<0.05). The ratio of patients with dyspnea, an lymphocyte count/neutral cell(LC/NC) ratio <1, mixed infections, lung consolidation and pleural effusion in the severe pertussis group was higher than that in the ordinary group ( χ2=116.940, 43.625, 13.253, 106.370, 11.874, all P<0.05). The patients in the severe pertussis group had a higher WBC [(61.66±29.63)×10 9/L vs.(18.83±10.00)×10 9/L, t=112.580, P<0.001] and a lower LC (0.494±0.186 vs.0.676±0.132, t=13.752, P<0.001) than those in the ordinary group.(4)Compared with the single infection group, the proportions of children with fever, dyspnea, fine moist lung rales, an LC/NC ratio <1, and lung consolidation were higher in the mixed infection group ( χ2=8.909, 6.804, 7.563, 8.420, 12.458, all P<0.05). More children in the mixed infection group required ICU hospitalization and mechanical ventilation than those in the single infection group ( χ2=11.677, 7.397, all P<0.05). The mixed infection group had higher respiratory failure and death rates than the single infection group ( χ2=7.980, 4.267, all P<0.05). Compared with the single infection group, the mixed infection group had a higher WBC level [(27.73±24.13)×10 9/L vs.(21.25±14.65)×10 9/L, t=13.318, P<0.001], longer hospitalization time [(11.593±9.010) d vs.(8.339±4.047) d, t=17.283, P<0.001], and a smaller LC ratio (0.626±0.165 vs.0.684±0.132, t=7.997, P=0.005). (5) Logistic regression analysis showed that age ≤3 months, peak WBC and dyspnea were risk factors of severe pertussis. Conclusions:Hospitalized pertussis children are prone to pneumonia and pulmonary consolidation.Patients aged ≤3 months with a large WBC and dyspnea easily develop into severe pertussis.Monitoring blood routine is helpful for judging the severity of the disease.Mixed infections increase the incidence of complications and can impair the treatment effect.

Objective The present study sought to explore the feasibility and effectiveness of lecture-based learning ( LBL ) , task-based learning ( TBL ) and problem-based learning ( PBL ) in clinical nursing teaching of department of cardiology.Methods A total of 139 practice nurses in the department of cardiology from September 2012 to September 2013 were divided into the control group and the experiment group according to random number table.The control group consisted of 68 practice nurses received traditional “one to one”education model, while 71 practice nurses were included in the experiment group with diversified teaching methods of LBL, TBL and PBL.Results The theoretical and practical exam results of experiment group were (91.8 ±3.6) and (92.4 ±2.9), which were significantly higher than those in the control group (t=7.89,5.51, respectively;P <0.05).The satisfaction of teaching in the experiment group was 84.5%, compared to 61.8% in the control group, the difference was statistically significont (u =2.1,P <0.05). Conclusions Diversified teaching methods of LBL, TBL and PBL can improve the effect of teaching, and was identified by practice nurses and clinical teachers.

Objective To analyze the effect of microRNA-22-3p(miR-22-3p)of extracellular vesi-cles derived from bone marrow mesenchymal stem cells on premature ovarian failure.Methods Follicular fluids were provided by premature ovarian failure patients with in vitro fertilization or the second-gen-eration in vitro fertilization treatment and normal volunteers with the same treatment for infertility due to male factors;the exosomes derived from bone marrow mesenchymal stem cells were isolated by dif-ferential centrifugation;the morphology,particle size and marker proteins of isolated exosomes were analyzed by transmission electron microscopy,NanoSight LM10 analyzer and Western blotting.Granulosa cells were treated with cyclophosphamide(CTX),exosomes,miR-22-3 mimics and corresponding controls,and were divided into CTX group,control group,exosome incubation group,PBS treat-ment group,CTX+miR-22-3p group,CTX+miR-NC group,CTX+Exosomes group,and CTX+PBS group;gene expression was detected by Western blotting and quantitative real-time polymerase chain reaction(qRT-PCR).The 3-(4,5-Dimethylthazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)reagent and flow cytometry were used to detect cell viability and apoptosis.Results The extracted exosomes had typical goblet vesicles,the exosome marker proteins C cluster of differentia-tion 63(CD63)and C cluster of differentiation 9(CD9)were expressed in the extracted exosomes,and exosome particle size was 80 to 150 nm;miR-22-3p was significantly lowly expressed in patients with premature ovarian failure and ovarian granulosa cells induced by CTX(P＜0.05),but was significantly highly expressed in ovarian granulosa cells incubated with exosomes derived from bone marrow mesenchymal stem cells(P＜0.05);the activity of granulosa cells in the CTX group was significantly lower than that in the control group,but was significantly higher in the CTX+miR-22-3p group or CTX+Exosomes group than that in the control group(P＜0.05);the apoptosis rate of granulosa cells in the CTX group was significantly higher than that in the control group,but was sig-nificantly lower in the CTX+miR-22-3p or CTX+Exosomes group than that in the control group(P＜0.05).Conclusion The miR-22-3p of extracellular vesicles derived from bone marrow mes-enchymal stem cells can inhibit ovarian granulosa cell injury induced by CTX.

Objective To analyze the effect of microRNA-22-3p(miR-22-3p)of extracellular vesi-cles derived from bone marrow mesenchymal stem cells on premature ovarian failure.Methods Follicular fluids were provided by premature ovarian failure patients with in vitro fertilization or the second-gen-eration in vitro fertilization treatment and normal volunteers with the same treatment for infertility due to male factors;the exosomes derived from bone marrow mesenchymal stem cells were isolated by dif-ferential centrifugation;the morphology,particle size and marker proteins of isolated exosomes were analyzed by transmission electron microscopy,NanoSight LM10 analyzer and Western blotting.Granulosa cells were treated with cyclophosphamide(CTX),exosomes,miR-22-3 mimics and corresponding controls,and were divided into CTX group,control group,exosome incubation group,PBS treat-ment group,CTX+miR-22-3p group,CTX+miR-NC group,CTX+Exosomes group,and CTX+PBS group;gene expression was detected by Western blotting and quantitative real-time polymerase chain reaction(qRT-PCR).The 3-(4,5-Dimethylthazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)reagent and flow cytometry were used to detect cell viability and apoptosis.Results The extracted exosomes had typical goblet vesicles,the exosome marker proteins C cluster of differentia-tion 63(CD63)and C cluster of differentiation 9(CD9)were expressed in the extracted exosomes,and exosome particle size was 80 to 150 nm;miR-22-3p was significantly lowly expressed in patients with premature ovarian failure and ovarian granulosa cells induced by CTX(P＜0.05),but was significantly highly expressed in ovarian granulosa cells incubated with exosomes derived from bone marrow mesenchymal stem cells(P＜0.05);the activity of granulosa cells in the CTX group was significantly lower than that in the control group,but was significantly higher in the CTX+miR-22-3p group or CTX+Exosomes group than that in the control group(P＜0.05);the apoptosis rate of granulosa cells in the CTX group was significantly higher than that in the control group,but was sig-nificantly lower in the CTX+miR-22-3p or CTX+Exosomes group than that in the control group(P＜0.05).Conclusion The miR-22-3p of extracellular vesicles derived from bone marrow mes-enchymal stem cells can inhibit ovarian granulosa cell injury induced by CTX.

Alcohol abuse leads to alcoholic liver disease and no effective therapy is currently available. Wuzhi Tablet (WZ), a preparation of extract fromthat is a traditional hepato-protective herb, exerted a significant protective effect against acetaminophen-induced liver injury in our recent studies, but whether WZ can alleviate alcohol-induced toxicity remains unclear. This study aimed to investigate the contribution of WZ to alcohol-induced liver injury by using chronic-binge and acute models of alcohol feeding. The activities of ALT and AST in serum were assessed as well as the level of GSH and the activity of SOD in the liver. The expression of CYP2E1 and proteins in the NRF2-ARE signaling pathway including NRF2, GCLC, GCLM, HO-1 were measured, and the effect of WZ on NRF2 transcriptional activity was determined. We found that both models resulted in liver steatosis accompanied by increased transaminase activities, but that liver injury was significantly attenuated by WZ. WZ administration also inhibited CYP2E1 expression induced by alcohol, and elevated the level of GSH and the activity of SOD in the liver. Moreover, the NRF2-ARE signaling pathway was activated by WZ and the target genes were all upregulated. Furthermore, WZ significantly activated NRF2 transcriptional activity. Collectively, our study demonstrates that WZ protected against alcohol-induced liver injury by reducing oxidative stress and improving antioxidant defense, possibly by activating the NRF2-ARE pathway.