Objective:To compare the effects of standard cognitive behavioral therapy for insomnia (CBT-I) and enhanced cognitive behavioral therapy for insomnia(CBT-I Plus) in patients with chronic insomnia disorder comorbid anxiety or depressive symptoms.Methods:This prospective study included 148 patients with chronic insomnia disorder and anxiety/depression symptoms who were treated at the Sleep Disorder clinic of Shanghai Mental Health Center between July 2020 and August 2023. Participants (56 males, 92 females; aged 18-65 years, mean age 35.08±10.30 years) were randomly assigned in a 1∶2 ratio to the CBT-I group ( n=54) or CBT-I Plus group ( n=94). The CBT-I Plus group received additional treatments targeting anxiety and depressive symptoms. Treatment lasted 8 weeks, with assessment conducted at baseline, weeks 2, 4, and 8. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HAMD 17), anxiety severity with the Hamilton Anxiety Scale (HAMA), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Paired sample t-tests were used to evaluate within-group changes, repeated-measures ANOVA compared treatment effects between groups, and ANCOVA was employed to adjust for confounding variables. Results:Significant reductions in PSQI, HAMD 17, and HAMA scores were observed in both groups after treatment: CBT-I group: PSQI ((14.15±2.54) vs. (7.50±3.35), t=13.25), HAMD 17 ((14.70±4.09) vs. (7.40±4.61), t=9.33), and HAMA ((14.94±4.11) vs. (5.56±3.67), t=12.38) (all P<0.001).CBT-I Plus group: PSQI ((14.87±3.01) vs. (7.19±3.86), t=18.75), HAMD 17 ((16.84±3.91) vs. (6.84±4.79), t=17.42), and HAMA ((15.57±3.93) vs. (6.10±4.57), t=18.39) (all P<0.001). After adjusting for HAMD 17 scores and medication use, no statistically significant between-group differences were observed in changes in PSQI, HAMD 17, and HAMA scores ( P>0.05). A significant time-by-group interaction was found for the PSQI daytime dysfunction subscale ( F=4.87, P<0.01). Conclusion:Both CBT-I and CBT-I Plus improve sleep and emotional symptoms in patients with chronic insomnia disorder and comorbid anxiety/depression symptoms. However, CBT-I Plus has no significant advantages over standard CBT-I. Further studies are needed to refine the timing and content of interventions.

Objective:To compare the effects of standard cognitive behavioral therapy for insomnia (CBT-I) and enhanced cognitive behavioral therapy for insomnia(CBT-I Plus) in patients with chronic insomnia disorder comorbid anxiety or depressive symptoms.Methods:This prospective study included 148 patients with chronic insomnia disorder and anxiety/depression symptoms who were treated at the Sleep Disorder clinic of Shanghai Mental Health Center between July 2020 and August 2023. Participants (56 males, 92 females; aged 18-65 years, mean age 35.08±10.30 years) were randomly assigned in a 1∶2 ratio to the CBT-I group ( n=54) or CBT-I Plus group ( n=94). The CBT-I Plus group received additional treatments targeting anxiety and depressive symptoms. Treatment lasted 8 weeks, with assessment conducted at baseline, weeks 2, 4, and 8. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HAMD 17), anxiety severity with the Hamilton Anxiety Scale (HAMA), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Paired sample t-tests were used to evaluate within-group changes, repeated-measures ANOVA compared treatment effects between groups, and ANCOVA was employed to adjust for confounding variables. Results:Significant reductions in PSQI, HAMD 17, and HAMA scores were observed in both groups after treatment: CBT-I group: PSQI ((14.15±2.54) vs. (7.50±3.35), t=13.25), HAMD 17 ((14.70±4.09) vs. (7.40±4.61), t=9.33), and HAMA ((14.94±4.11) vs. (5.56±3.67), t=12.38) (all P<0.001).CBT-I Plus group: PSQI ((14.87±3.01) vs. (7.19±3.86), t=18.75), HAMD 17 ((16.84±3.91) vs. (6.84±4.79), t=17.42), and HAMA ((15.57±3.93) vs. (6.10±4.57), t=18.39) (all P<0.001). After adjusting for HAMD 17 scores and medication use, no statistically significant between-group differences were observed in changes in PSQI, HAMD 17, and HAMA scores ( P>0.05). A significant time-by-group interaction was found for the PSQI daytime dysfunction subscale ( F=4.87, P<0.01). Conclusion:Both CBT-I and CBT-I Plus improve sleep and emotional symptoms in patients with chronic insomnia disorder and comorbid anxiety/depression symptoms. However, CBT-I Plus has no significant advantages over standard CBT-I. Further studies are needed to refine the timing and content of interventions.

Objective:The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia (CBT-I) from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods:Using qualitative research methods, 21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times. Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD 17), and Hamilton Anxiety Scale (HAMA) were assessed at baseline and the end of the 8th week of treatment. The paired sample t-test was conducted. Semi-structured interviews were performed at week 2, week 4, and week 8 respectively and thematic analysis was used to code and analyze the interview data. Results:Compared with baseline data, the symptoms of insomnia (13.6±2.0 vs. 6.9±2.4), depression (14.6±5.5 vs. 5.0±3.6), and anxiety (17.2±3.4 vs. 5.3±3.9) were significantly improved after 8 weeks of CBT-I treatment ( t=-3.31, -3.19, -2.94, all P<0.01). The patient factors influencing the efficacy of CBT-I were treatment expectation and approval, motivation, compliance, and internalization of treatment content. The therapist factors were professionalism, well-directed, treatment style, supervision, and giving hope. Conclusion:Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I. Therapists should have sufficient experience, stimulate patients′ motivation, improve patients′ compliance, and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

Objective:The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia (CBT-I) from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods:Using qualitative research methods, 21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times. Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD 17), and Hamilton Anxiety Scale (HAMA) were assessed at baseline and the end of the 8th week of treatment. The paired sample t-test was conducted. Semi-structured interviews were performed at week 2, week 4, and week 8 respectively and thematic analysis was used to code and analyze the interview data. Results:Compared with baseline data, the symptoms of insomnia (13.6±2.0 vs. 6.9±2.4), depression (14.6±5.5 vs. 5.0±3.6), and anxiety (17.2±3.4 vs. 5.3±3.9) were significantly improved after 8 weeks of CBT-I treatment ( t=-3.31, -3.19, -2.94, all P<0.01). The patient factors influencing the efficacy of CBT-I were treatment expectation and approval, motivation, compliance, and internalization of treatment content. The therapist factors were professionalism, well-directed, treatment style, supervision, and giving hope. Conclusion:Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I. Therapists should have sufficient experience, stimulate patients′ motivation, improve patients′ compliance, and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

Objective To explore the effect of sitting and lateral sputum aspiration on the retention time of tracheal cannula in patients with neurosurgical tracheotomy. Methods Totally 120 cases of neurosurgery tracheotomy in hospitalized patients complicated with pulmonary infection by random number table method, 58 cases were divided into experimental group and control group 62 examples, two groups of patients with sputum top all joint taps to the back of the chest, the experimental group after taps take seat effectively causes cough; In the control group, the lateral position was used to effectively cough or induce cough, and the daily sputum volume of the two groups of patients was observed. To observe the time when the body temperature was restored to normal after the phlegm of the two groups of patients, the time of the lung auscultation, and the time of the tracheal tube retention. Results Implementing position row of phlegm daily sputum volume within a week the experimental group were (44.84±6.85) ml, (44.60±6.80) ml, (43.79±5.98) ml, (44.38±5.42) ml, (42.22±5.45) ml, (38.12±4.77) ml, (36.88±4.57) ml and control group were(36.13±7.34) ml, (35.15±7.34) ml, (36.13±7.34) ml, (37.13±7.34) ml, (37.13±7.34) ml, (32.97±7.17) ml, (31.35±4.36) ml, the difference had statistical significance (t=4.30-7.31, P<0.01);In the two groups, the time of normal body temperature recovery, the time of hearing and the time of the lung and the time spent in the tracheal tube were compared, and the experimental group were respectively (9.93±2.02) d, (32.33±1.50) d, (37.33±1.50) d, while control group were(15.77±1.05) d, (37.63 ± 2.33) d, (42.63 ± 2.33) d, the difference had statistical significance (t=20.04, 14.71, P<0.01). Conclusions It is better to reduce the retention time of tracheal tube in patients with neurosurgical patients than the lateral position.

Objective To investigate the change of expression patterns of miRNA in the serum and peripheral blood mononuclear cells (PBMC) of lung cancer and its significance.Methods Clinical case control study was employed.Establish the method of microRNA(miRNA) detection by real time quantitative PCR (RT-qPCR).peripheral blood of the study subjects were collected in First affiliated hospital of SooChow University from November 2011 to September 2012.Gender and age matched subjects whose median age was 64(40-85) included 61 lung cancer cases,48 healthy control and benign lung diseases.We used quantitative RT-PCR to assess miRNA expression pattern of-miR-20a,21,-25,-29,-31,-126,-129,-145 and -205 in peripheral blood.U6 was taken as reference,and the expression of miRNA were indicated as F =2-△Ct,ACt =CtmiRNA--CtU6.F represents relative change of miRNA expression compared to U6 in the same sample.SPSS 19.0 was used as statistical software; t test was used for comparison of two sets of samples One way ANOVA was used for multiple groups' comparison,and make multiple comparison by the S-N-K method if the result with a significant difference.Pearson correlation analysis were used for the relationship between two variables,Brown-Forsythe test was used for Ct value equality testing among multiple samples.P ＜ 0.05were regarded as statistically significant.Results miR-20a (F =271.64,P ＜ 0.01),miR-21 (F =2232.51,P＜0.01),miR-205 (F=45.13,P＜0.01),miR-29a (F=19.98,P ＜0.01),miR-25 (F=313.19,P ＜ 0.01) and miR-126 (F =32.38,P ＜ 0.01) were differently expressed in the serum of lung cancer patients and healthy control or benign disease control.miR-29a,miR-25,miR-126 was down regulated in the development of malignant lung disease; miR-31 elevated in lung cancer compared with healthy control,while miR-145 fell; miR-31 expression changed with various differentiation of lung cancer (F =5.22,P ＜ 0.01)itwas significantly increased in the moderate-differentiated cancer,but decreased when distant metastasis existed (especially bone metastasis).But in PBMC paired with the serum samples above,statistically significance was shown in lung cancer and healthy control group and benign lung diseases group in miR-126 (F=690.58,P＜0.01),miR-129 (F=26.66,P＜0.01),miR-145 (F=48.57,P＜0.01),miR-205 (F=308.61,P＜0.01).miR-25 (F=218.57,P＜0.01) and miR-31 (F=48.05,P＜0.01),were down regulated in the development of malignant lung disease.miR-20a,miR-29a were elevated in lung cancer compared to healthy controls,miR-21 was up-regulated when distant metastasis existed; the expression of miR-31 in serum and PBMC was negatively correlated (r =-0.369,P ＜ 0.05).Areas under ROC curve of miR-25 (S =0.906,P ＜ 0.01) and miR-126 (S =0.969,P ＜ 0.01) were statistically different.Conclusions miRNA may contribute to several steps of metastasis,including local invasion,extravasation or initial survival at a distant site,and metastatic colonization,or can affect the prognosis of lung cancer.The detection of miRNA in lung cancer provides a new clue to the research of its chronic progress.

Thyroid hormone insensitive syndrome is an inherited disease characterized by decreased target tissue responsiveness to thyroid hormone. Most cases are due to thyroid hormone receptor β gene mutation. Two novel types of thyroid hormone insensitive syndrome were recently identified, which are caused by gene mutations of MCT8, a specific thyroid hormone transporter, and SBP2 in the synthesis of deiodinase.

BACKGROUND: Based on the characteristics of cartilage tissue, such as consisting of single type of cells, the cartilage cells or chondrocyte, absence of blood vessel, rather low consumption level of oxygen and nutrition, low level of allo-immunocompetence and simple function in vivo, it seems to be easy for cartilage cell lines to be established for tissue and cell transplantation. We want to set up a cell line with the purpose of current use in tissue engineering in vitro. It will provide the basis for artificial tissue and organ that will become to be standardized and yielded in batch.OBJECTIVE: To explore the potential stimulatory effects of basic fibroblast growth factor(bFGF) and insulin on the proliferation and differentiation in primary culture mice chondrocytes in vitro. The effect and application of the cell factors will be evaluated for tissue engineering.DESIGN: A grouping controlled and repeated trial was conducted with the cells as the subjects.SETTING: Key laboratory of tissue transplantation and immunology of a college.MATERIAIS: The experiment was completed in the Key Laboratory of Tissue Transplantation and Immunology of the Ministry of Education, Jinan University from November 2002 to May 2003. Cultured cartilage cells at random were obtained as the study objects.METHODS: Mice cartilage cells were cultured in medium at the minimum concentrations of serum. The effects of different concentration of bFGF and insulin on the proliferation and differentiation in mice cartilage cells were observed with WST1 and immunofluorescence staining.MAIN OUTCOME MEASURES: Primary results: ① Effect of bFGF on proliferation of primary cultured mice cartilage cells. ② Effect of insulin on proliferation of primary cultured mice cartilage cells. Secondary results:morphological observation of cartilage cells RESULTS: Primary cultured mice cartilage cells were cultured in medium at the minimum concentration of serum(4 g/L fatal bovine serum). It was found that bFGF and insulin might play an important role on the proliferation and growth of mice cartilage cells in a dose-dependent manner. In addition, morphological observation of cartilage cells showed that both bFGF and insulin not only promoted the proliferation of the cells but also enhanced the matrix secretion of cartilage cells.CONCLUSION: Both bFGF and insulin can stimulate the proliferation of cartilage cells in vitro.

OBJECTIVE:To study the vitro antibacterial activity of domestic teicoplanin against224strains of enterococ-ci.METHODS:Determination of MIC of domestic teicoplanin against169strains of entercococcus faecalis and51strains of E.faecium was tested by agar dilution method,and its antibiotic effect was compared with that of the imported teicoplanin and other antibiotics.RESULTS:The MIC 50 of domestic teicoplanin against169strains of E.faecalis and51strains of E.faecium were0.125,0.25?g/ml respectively,MIC 90 were2,1?g/ml respectively;The MIC 50 of imported teicoplanin against E.faecalis and E.faecium were0.25,0.25?g/ml respectively,MIC 90 were1,0.5?g/ml respectively.CONCLUSION:Two kinds of te-icoplanin have strong antibacterial activity against224strains of enterococci;the sensitivity of224strains of enterococci to both kinds was100%.

AIM: In order to understand the pathological changes, characteristic of degeneration in optic nerve and retina after strike of optic nerve. METHODS: According to methods of Allen's spinal injury, a 600gcm-strike power was put on the intraocular portion of the optic nerve and created a striking injury on optic nerve. After a survival interval of 48 h, 1 week, 2 weeks, 4 weeks, 3 months, the animal's optic nerves and retinas were collected and fixed for morphological examination. RESULTS: Forty-eight hours after nerve injuries, the optic nerves were slight enlargement and vacuolation. In 1 week, the optic nerve began to degenerate in injured part and the glia cell had proliferated, but the forms of retinal ganglion cells(RGCs) were normal. In 2 weeks, the vacuolation and focal necrosis were appeared between nerve fiber. The number of RGCs began to decrease. Condensed nuclei presented in the retina. In three month, the diameter of the optic nerve decreased in injury part and collo-scar was formed. The phenomenon mentioned above was more obviously. The internal nuclear neurons and outer nuclear neurons appeared rare. The thickness of retina decreased. The number of RGCs began to decrease in 48 hours and progressed thereafter. It decreased about 3.35%, 13.23%, 19.74%, 23.20%, 29.28% in 48 h, 1 week, 2 weeks, 1 month, 3 months compared with the number of normal RGCs. RGCs began to apoptosis in 48 h. CONCLUSION: The model in this experiment could make definite uncompleted optic nerve and retina injuries. The degree of neuron injuries decreased from RGC, internal nuclear neurons to outer nuclear neurons. The number of RGCs began to decrease in 48 hours, and most quickly periods from 48 hours to one week.