Alzheimer disease(AD),commonly known as senile dementia,is the most common type of dementia,resulting in progressive impairment of cognitive function,and is often accompanied by a variety of psychiatric symptoms,such as agitation.Agitated symptoms in AD patients often cause an increasing burden on caregivers,and current psychiatric medications may exacerbate adverse effects such as cognitive impairment and motor retardation in patients.Therefore,non-drug intervention is a very important adjuvant treatment option.This article reviews the clinical manifestations,possible mechanisms,drug therapy and non-drug intervention measures of agitation in order to provide reference for more effective treatment of AD.

Objective: To investigate the effect of clinical psychological nursing intervention on negative emotion and quality of life in patients with palliative treatment of digestive tract malignancies. Methods: From June 2016 to June 2018, 100 patients with palliative treatment of digestive tract malignancies admitted to the first people′s hospital of Tianmen city as subjects. According to the random number table, patients were divided into control group and observation group, with 50 in each group. The control group received routine nursing intervention and the observation group received clinical psychological nursing intervention.The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Quality of Life Measurement Scale (EORTC QLQ-C30) were used to assess the mental state and quality of life of patients, and the differences of the above indicators before and after intervention were compared. Results: After intervention, the HAMD score and HAMA scores in the observation group were (11.22±1.97) and (8.31±1.77), those scores in the control group were (14.58±2.16) and (9.35±2.49), the difference was statistically significant (t=8.008, 2.367, all P<0.05). After the intervention, the scores of role function, emotional function, fatigue, pain, appetite loss and overall quality of life in the observation group were (68.74±25.93), (72.41±21.70), (47.28±15.66), (30.08±12.10), (26.70±9.13) and (76.85±19.66); however, the socres mentioned above were (57.42±26.35), (62.16±21.52), (56.44±14.90), (37.25±15.18), (30.44±9.30), (67.93±20.75) in the control group. The scores role function, emotional function and overall quality of life were significantly increased in the observation group compared to the control group, while fatigue, pain and appetite loss scores were significantly decreased in the observation group compared to the control group (t=1.999-2.950, all P<0.05). Conclusions Patients with palliative treatment of digestive tract malignant tumors have obvious negative emotions. Clinical psychological nursing intervention can effectively alleviate negative emotions and improve quality of life. It can be used as an auxiliary method during palliative treatment of malignant tumors of digestive tract.

Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound . Methods Ninety-five fetuses with a little or mild tricuspid regurgitation ( control group) and 60 fetuses with moderate and severe tricuspid regurgitation (observation group) were included . The degree ,velocity ,and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared . As for the follow -up on observation group ,the pressure of fetus with high pulmonary systolic pressure ( > 20 mmHg) was repeatedly measured every 4 weeks until it return to normal . Results There were significant differences in terms of gestational weeks ,velocity and pressure of tricuspid regurgitation ,as well as pulmonary systolic pressure between the two groups ( P < 0 .001) . Pulmonary systolic pressure was positively correlated with gestational weeks , velocity and pressure of tricuspid regurgitation ( r = 0 .442 ,0 .998 ,0 .999 ;all P < 0 .001 ) ,but had no correlations with the age of pregnant women ( r = - 0 .001 , P = 0 .674) . The follow-up revealed that ,in observation group , 47 cases ( 78 .3％ , systolic pressure < 50 mmHg ) presented with the decreased pulmonary systolic pressure ,the disappeared or the slight appeared regurgitation before birth ,meanwhile , 13 ( 21 .7％ ,systolic pressure ≥ 50 mmHg) exhibited severe tricuspid regurgitation and persistent pulmonary elevation ,with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure . Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia ( oxygen saturation <45％ ) . The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth ,with normal heart function . Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid regurgitation is reversible functional alteration , which can restore normality in most cases before or after birth .

Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures.Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014.They were 69 men and 40 women,23 to 72 years of age (average,46.3 years).By the Tile classification,15 cases were type B1,37 type B2,14 type B3,19 type C1,16 type C2,and 8 type C3.Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation.There were 86 cases in the good-to-excellent group (78.9％) and 23 in the fair-to-poor group (21.1％).Their data were analyzed in terms of gender,age,preoperative injury severity scale (ISS),body mass index (BMI),operation time,fracture type,reduction quality,postoperative complications,bone density,and postoperative weight bearing time.The influential factors were determined using Logistic regression analysis.Results All the 109 patients obtained a mean follow-up of 18.7 months (from 12 to 53 months).Preoperative ISS (P =0.000),fracture type (P =0.008),reduction quality (P =0.009) and postoperative complications (P =0.000) were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures.Conclusion Preoperative assessment by ISS,a clear understanding of the pelvic fracture type,anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.

Objective To explore sonographic manifestation of fetal malformations of cortical development.Methods From August 2012 to January 2014 three hundred and twenty-five pregnancy women referred to our institution for fetal brain MRI,which were diagnosed or suspected of central nervous system abnormalities by prenatal ultrasound examination.Results In 325 of cases,14 cases (4％) were diagnosed of malformations of cortical development.Ten eases were indicated by prenatal ultrasound,including three cases of heterotopic gray matter,six cases of microcephaly and one case of hemimegalencephaly; four cases were missed by prenatal ultrasound,including two cases of schizencephaly,one case of tuberous sclerosis,and one case of hypoplasia.Conclusions Cortical malformations can be diagnosed by prenatal ultrasonography based on typical imaging characteristics.Prenatal ultrasound combined with MRI is a powerful tool in diagnosing fetal malformations of cortical development.

Objective To study the effects of repeated hypoxic exposures (HEs) on glycolysis, mitochondrial oxi-dative phosphorylation and energy charge in mouse brain. Methods Adult BALB/c mice were repeatedly exposed to hypoxia for 5 times and the standard tolerant time and body temperature were recorded. The activities of PFK, PK and mitochondrial complex Ⅰ in the brain were assayed. Phosphoadenosines and energy charge were measured. Results Repeated HEs prolonged the hypoxic tolerance and reduced the body temperature. The activities of PFK and PK experienced regular changes, with an increase in 1st and 3rd HEs and a decline to control levels in 5th HE. The complex Ⅰ activity continued to decrease during HEs. The energy charge was stable. Conclusion HEs lead to a regular change of glycolysis, a continued inhibition of mitochondrial oxidative phosphorylation, and a main-tained energy charge in the brains of mouse.

Objective To evaluate the application of the transurethral vapor-resection of the prostate(TU- VRP) for bladder outlet obstruction(BOO) in patients with prostate eaneer(PCa). Methods Of 33 patients with BOO. 18 were definitely diagnosed with PCa and after treatment they still had symptoms of BOO;15 cases were di- agnosed with benign prostate hyperplasia(BPH). All patients underwent TUVRP for BOO. Results All cases were successfully done. Postoperative complications included transient urinary ineontinenee in 5 ,and gross hematuria in 9. 27 patients were followed up(10-36 months).8 cases died of PCa,with a mean survival of 31 months.5 cases died of other diseases. After treatment, PSA levels decreased to ( 10.2 ± 6.7) μg/L. The average residual urinary volume (RU) decreased to (39.7 ± 13.9) ml, and the average IPSS was (8.7 ± 1.6 ). Compared with those of preoperation, the differences were statistically significant ( P < 0.05 ). Conelnsion TUVRP is a reliable treatment for prostate cancer with bladder outlet obstruction.

Objective To investigate the therapeutic effects of cystitis glandularis by TUR. Methods The clinical data of 40 patients with cystitis glandularis who were treated with TUR, transurethal plasma kinetic resection or postoperative mitomycin instillation of bladder in our hospital from January 2003 to December 2006 were retrospectively analyzed. Results Vesical perforation occurred in 2 patients,and the complications of urinary incontinence and vesical neck constriction were not observed postoperatively. 37 patients were followed up for an average of 1.8years, 32 patients were cured ,3 patients turned better, 2 patients reoccurred, and no cancer was observed. Conclusion The transurethra resection combined with mitomycin irrigation of bladder has satisfactory therapeutic effects on cystitis glandularis,and there are fewer adverse reaction and can be taken as the primary choice for treating cystitis glandularis.

BACKGROUNDUp to now, locally advanced non-small cell lung cancer simutaneously involving carina, heart and great vessels is still regarded as contraindication for surgical treatment. However, the prognosis is very poor in these patients treated with chemotherapy and/or chemoradiotherapy. The aim of this study is to summarize the clinical experiences of carinoplasty combined with heart and great vessel plasty in the treatment of 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels or both in our hospital.

METHODSFrom March, 1988 to December, 2004, carinal resection and reconstruction combined with heart, great vessel plasty was performed in 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously. The operative procedures in this series included as follows: (1) Right upper sleeve lobectomy combined with carinal resection and reconstruction, and right pulmonary artery sleeve angioplasty in 9 patients; (2) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium, and superior vena cava resection and Gortex grafts in 3 cases; (3) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 3 cases; (4) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 10 cases; (5) Left upper sleeve lobectomy combined with carinoplasty and left pulmonary artery angioplasty in 9 cases; (6) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and resection of the aorta arch sheath in 6 cases; (7) Right upper-middle sleeve lobectomy combined with carinoplasty and right pulmonary artery sleeve angioplasty in 3 cases; (8) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery angioplasty, resection of the aorta arch sheath and partial resection and reconstruction of left artium in 8 cases; (9) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 4 cases; (10) Left sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 3 cases; (11) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and superior vena cava resection and reconstruction with Gortex grafts in 23 casese; (12) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 1 case; (13) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 1 case; (14) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and right inferior pulmonary vein sleeve resection and reconstruction in 1 case.

RESULTSThere were two operative death in this series. The operative mordality was 2.38%. A total of 32 patients had operative complications. The incidence of operative complications was 38.10%. The 1-, 3-, 5-and 10-year survival rate was 81.34%, 59.47%, 31.73% and 24.06% respectively.

CONCLUSIONS(1) It is feasible in technique that carinal resection and reconstruction combined with heart, great vessel plasty in the treatment of locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously; (2) Multiple modality therapy based on carinal resection and reconstruction combined with heart and great vessel plasty can remarkably increase the survival rate, and improve the prognosis and quality of life in patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels.

BACKGROUNDTo investigate the influence of tumor metastasis suppressor gene nm23-H1 on the activity of glycogen synthase kinase 3β (GSK-3β) in human high-metastasis large cell lung cancer cell line L9981.

METHODSThe levels of GSK-3β expression in cytoplasm and nucleus were determined with anti- GSK-3β antibody in human high-metastasis large cell lung cancer cell line L9981 (cell line with nm23-H1 gene deletion), L9981-nm23-H1 (cell line with nm23-H1 transfected) and L9981-pLXSN (cell line with vector transfected) by Western blot method. The activity of GSK-3β among those three cell lines was detected by immunoprecipitation and analysed by a radioactive isotope scintillation counter before and after treating with 20 mmol/L LiCl.

RESULTS(1) The expression indensity of GSK-3β of cytoplasm and nucleus was (6 341±541) and (4 356±490) IOD in L9981-nm23-H1, (3 613±383) and (705±75) IOD in L9981-pLXSN, and (3 736±298) and (675±57) IOD in L9981, respectively. A high significance in GSK-3β expressive indensity of both cytoplasm and nucleus existed among L9981-nm23-H1, L9981-pLXSN and L9981 (P < 0.01); Multiple comparison: A highly significant difference was observed when L9981-nm23-H1 was compared with L9981-pLXSN or L9981 (P < 0.01), but no significant difference was observed between L9981-pLXSN and L9981 (P > 0.05). (2) The GSK-3β activity of cytoplasm and nucleus was (28 955±2 509) and (9 247±924) CPM in L9981-nm23-H1, (11 241±1 495) and (1 492±176) CPM in L9981-pLXSN, and (12 505±1 469) and (1 763±125) CPM in L9981, respectively. A highly significant difference in GSK-3β activity of both cytoplasm and nucleus existed among L9981-nm23-H1, L9981-pLXSN and L9981 (P < 0.01); Multiple comparison: the GSK-3β activity in L9981-nm23-H1 was significantly higher than that in L9981-pLXSN and L9981 (P < 0.01), but no significant difference was observed between the L9981-pLXSN and L9981 (P > 0.05). (3) After treatment with 20 mmol/L LiCl, the expressive indensity of GSK-3β of cytoplasm and nucleus was (4 718±549) and (3 823±350) IOD in L9981-nm23-H1, (2 030±155) and (217±15) IOD in L9981-pLXSN, and (2 164±151) and (224±19) IOD in L9981, respectively. No significant difference in GSK-3β expressive indensity existed between before and after treatment with LiCl in L9981-nm23-H1 (P > 0.05). However, the GSK-3β expressive indensity in cytoplasm and nucleus before treatment was remarkably higher than those after treatment in both L9981-pLXSN and L9981 (P < 0.05). (4) After treatment with 20 mmol/L LiCl, the GSK-3β activity in cytoplasm and nucleus was (11 099±1 112) and (3 748±215) CPM in L9981-nm23-H1, (4 447±430) and (1067±159) CPM in L9981, and (4 435±427) and (909±156) CPM in L9981-pLXSN, respectively. The GSK-3β activity both in cytoplasm and nucleus after treatment with LiCl was remarkably lower than that before treatment in L9981-nm23-H1, L9981-pLXSN and L9981 (P < 0.01 or P < 0.05).

CONCLUSIONS(1) Transfection of nm23-H1 gene can significantly up-regulate the expression level and activity of GSK-3β in human high-metastasis large cell lung cancer cell line L9981; (2) LiCl can remarkably suppress the upregulation effects of nm23-H1 gene on GSK-3β activity in L9981 cell line; (3) The effects of nm23-H1 gene on suppressing the signal transduction of Wnt pathway might be carried out through upregulating GSK-3β expression and activity in human high-metastasis large cell lung cancer cell line L9981.