Objective To explore the dilemma of self-management behavior maintenance in ischemic stroke patients,and to provide references for continuous self-management intervention design for ischemic stroke patients.Methods The descriptive qualitative research method was used to select samples by the purpose sampling method.From November to December 2023,18 patients hospitalised with stroke from the neurology ward of a tertiary general hospital in Luoyang City,Henan Province were selected for semi-structured interviews.Based on the Capability,Opportunity,Motivation-Behavior(COM-B)model,the data were analyzed by directed content analysis.Results A total of 3 themes and 12 sub-themes were identified,namely capability factors(poor level of health literacy,lack of self-control),opportunity factors(lack of medical resources impeding the maintenance of behaviors,social customs inducing the return of undesirable behaviors,difficult to satisfy the need for multiple emotional support,behavior being improved briefly after follow-up),and motivation factors(impulsive thinking,role conflict leading to forgetfulness,difficult to change previous bad habits,acceptance of the aging,weak self-management effect,symptoms inducing behavioral changes).Conclusion The maintenance of self-management behavior in ischemic stroke patients is affected by 3 aspects of obstacles,including capability,opportunity and motivation.On the premise of fully evaluating the specific characteristics of ischemic stroke patients,medical staff should meet the multidimensional needs of patients to promote the maintenance of self-management behaviors to improve their health outcomes.

Objective To explore the dilemma of self-management behavior maintenance in ischemic stroke patients,and to provide references for continuous self-management intervention design for ischemic stroke patients.Methods The descriptive qualitative research method was used to select samples by the purpose sampling method.From November to December 2023,18 patients hospitalised with stroke from the neurology ward of a tertiary general hospital in Luoyang City,Henan Province were selected for semi-structured interviews.Based on the Capability,Opportunity,Motivation-Behavior(COM-B)model,the data were analyzed by directed content analysis.Results A total of 3 themes and 12 sub-themes were identified,namely capability factors(poor level of health literacy,lack of self-control),opportunity factors(lack of medical resources impeding the maintenance of behaviors,social customs inducing the return of undesirable behaviors,difficult to satisfy the need for multiple emotional support,behavior being improved briefly after follow-up),and motivation factors(impulsive thinking,role conflict leading to forgetfulness,difficult to change previous bad habits,acceptance of the aging,weak self-management effect,symptoms inducing behavioral changes).Conclusion The maintenance of self-management behavior in ischemic stroke patients is affected by 3 aspects of obstacles,including capability,opportunity and motivation.On the premise of fully evaluating the specific characteristics of ischemic stroke patients,medical staff should meet the multidimensional needs of patients to promote the maintenance of self-management behaviors to improve their health outcomes.

Abstract Objective　To observe the dynamic changes of hippocampus microstructure in patients with cerebral infarction within the territory of the middle cerebral artery (MCA) with cortex involvement,thus exploring the relationship between these changes and the changes in semantic memory function.Methods　Twenty-two patients with acute subcortical infarction were assessed for cognitive function,structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) at 1,4,and 12 weeks (W) respectively.A total of 22 gender and age matched subjects were enrolled as healthy controls.Results　Bilateral hippocampal volume did not change significantly during the entire follow-up period.Spearman’s rank correlations showed that percent decreases in immediate recall and long-delay recall scores correlated negatively with percent increases in mean diffusivity (MD) values in the ipsilateral hippocampus (immediate,rs=0.683,P=0.006; long-delay,rs=-0.602,P=0.013).Conclusion　In patients with cerebral infarction within the territory of the MCA with cortex involvement,the microstructural integrity of the hippocampus may be damaged before the macrostructure changes,and these changes may be related to the decline of semantic memory.

Objective The aim of this study was to investigate the mechanism of sanguinarine(SANG)on the inhibitory pro-liferation in ovarian cancer SKOV3 cells. Methods CCK-8 assay was used to detect proliferation of SKOV3 cells. Flow cytometry was used to detect the effect of SANG on apoptosis in SKOV3 cells. The spectrophotometer was used to detect the production of reac-tive oxygen species(ROS)by SANG. The mouse ovarian cancer xenograft model was used to detect the inhibitory effect of SANG on tumor growth. Results SANG promoted apoptosis in SKOV3 cells in a dose-and time-dependent manner. The SANG-induced ap-optosis was associated with the production of ROS,Activated the c-Jun-N-terminal kinase( JNK) and nuclear factor-κB( NF-κB)signaling pathways. In mouse model of ovarian cancer xenografts,after intravenous injection of mice with SANG,SANG was signifi-cantly inhibited the growth of ovarian cancer xenografts when compared to the control group. SANG also significantly induced apoptosis in ovarian cancer xenografts. Conclusion SANG can significantly inhibit the proliferation of ovarian cancer SKOV3 cells,induce ap-optosis,increase the production of ROS,and inhibit the growth of ovarian cancer.

Objective To demonstrate the clinical characteristics and prognosis of invasive pulmonary aspergillosis (IPA) in respiratory intensive care unit (ICU), for early diagnosis and treatment. Methods The clinical features, treatment and outcome of 17 patients diagnosed as IPA in RICU from May 2015 to April 2018 were analyzed retrospectively. Results The basic diseases of 17 patients were mostly chronic respiratory diseases (14 cases, while 11 cases were chronic obstructive pulmonary disease). One case was proven by IPA criteria, 13 cases were probable and 3 cases were possible. All patients were treated with broad-spectrum antibiotics during hospitalization, and 6 patients were treated with glucocorticoids (oral/intravenous) within 3 weeks of admission and during hospitalization. The main clinical symptoms included cough sputum, dyspnea and fever, among which 4 cases had hemoptysis. Infiltrates were seen in 8 cases, multiple nodules with cavitary lesions in 4 cases, multiple small nodules along the bronchi in 2 cases, and left upper lobe consolidation in the proven case. Sixteen patients were treated with voriconazole alone or in combination with caspofungin. Fourteen patients were tested for voriconazole serum concentration, while 4 were in normal range, 10 were elevated (2 cases were significantly elevated, ＞10 μg/L). Serum concentration of bilirubin did not increase significantly in all paitents after treatment. Serum concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in 4 cases with elevated serum concentration of voriconazole and 2 cases with normal serum concentration of voriconazole. Patients with elevated voriconazole concentration did not show significant difference in prognosis compared with those with normal concentration. Eight cases were improved and discharged and 9 gave up and died due to the worsening of the disease. Eight patients received mechanical ventilation (6 cases were invasive and 2 cases were non-invasive), 7 of them eventually gave up treatment and died. Conclusions The clinical features of chronic respiratory diseases with IPA are atypical, however, the patient is critically ill with high mortality. Elevated serum concentration of voriconazole might be more common in severe patients. For those who have a history of systemic application of glucocorticoids, clinical symptoms with hemoptysis, short of breath, radiology with infiltrates, nodular and/or with cavity, and with no response to antibiotics, clinicians should actively seeking evidence of IPA, for early diagnosis, standardized treatment, and improve the prognosis of patients with chronic respiratory diseases complicated with IPA.

Nosocomial infection is one of the most common diseases in the intensive care unit (ICU), which has received much concern due to its multi-type infection, more severe infection, difficulty in treatment and high mortality. However, the drug resistance of bacteria is increasingly serious with the wide use of the antibiotics which is no longer an ideal strategy. Instead, the control and prevention of infection from their sources is the key to reduce ICU infection. Especially for some particular nosocomial infections, such as hospital acquired pneumonia (HAP) and ventilator associated pneumonia(VAP), comprehensive measures are needed to take to break the spell of ICU infection.

Invasive pulmonary aspergillosis is valued in intensive care unit (ICU) patients, but in ICU patients, the diagnosis standard of the European Organization for Research on the Treatment of Cancer/Mycosis Study Group (EORTC/MSG) could easily lead to misdiagnosis and missed diagnosis. It’s imaging manifestations are diverse: halo sign, nodules or micro nodules, nodular shadow, pulmonary consolidation, wedge-shaped consolidation, voids, air crescent sign, ground glass shadow, and so on, and with the relative characteristic features. The sensitivity and specificity of galactomannan detection in bronchoalveolar lavage fluid (BALF) are high for diagnosis of invasive pulmonary aspergillosis in ICU patients, but the significance of the cultivation of lower respiratory tract specimens is limited.

Objective Toll-like receptor ( TLR) gene family is the most important pathogen recognition receptor and animal experiment have found TLR4 mice is inclined to infect aspergillosis ( IA) .The study was to investigate the variation of TLR4 gene in Chinese Han nationality and its relation with the susceptibility of IA. Methods 25 patients diagnosed with proven IA from June 2011 to December 2012 in our hospital were enrolled, among which 17 were males.Their average age was 52.4 ±12.3, and 12 pa-tients had underlying diseases, the others had no underlying diseases.The control group consisted of 103 normal persons, among which 70 were males.Their average age was 56.0 ±17.2.All of the subjects were Chinese Han population.DNA was extracted from periph-eral blood.Polymerase chain reaction ( PCR) was applied to amplify the coding sequence of TLR4 gene followed by sequencing.The sequencing result was compared with TLR4 coding sequence in NCBI GenBank along with the analysis on amino acid change caused by genetic mutation and its effect on protein function.Comparison analysis was made on genetic mutation rate between IA group and con-trol group. Results Two missense mutations,TLR4 219 C>G and 1420 C>T, were identified in TLR4.The prediction result of protein structure showed 219 C>G resulted in the change of functional area for TLR4 to recognize pathogen and 1420 C>T caused no change in domains.The variation rate of TLR4 in IA group was 8%( 2/25 ) and both the patients had no underlying diseases. No mutation has been founded in control group and the difference between two groups was of statistical significance (P=0.037). Conclusion Two missense mutations (219 C>G and 1420 C>T) have been detec-ted in encoding area of TLR4 gene of IA patients.Variation in the cod-ing region of TLR4 gene may increase the susceptibility to IA.

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

Objective To develop a scale of social adaptation degrees of special service personnel (referred to as scale) applying Traditional Chinese Medicine and psychological theory and to assess its reliability and validity. Methods By literature review, job analysis, inventory survey, topics interview, this scale was determined in dimensions, items and items pool based on theoretical model. Results After specialist important analysis and combining the different results of statistical analysis, including Cronbach's α coefficient, resolution factor, correlation analysis and confirmatory factor analysis, 6 dimensions, 14 factors and 40 items were finally kept in the scale. The dimensions were psychological characteristics, physical condition, intelligence level, interpersonal relationships, environmental factors and moral character. The factors were self-control, self-esteem character bias, self-confidence, physiological function, learning intelligence, creating intelligence, leadership intelligence, gregariousness, cooperative, confidence feeling, natural environment, social environment and moral character. Conclusion This scale was made on the basis of general international principle, it had good reliability and validity meeting measurement standard of traditional Chinese medicine and psychological theory, and it is an effective and practical evaluation tool of social adaptation degrees of special service personnel.