Objective To investigate the predictive value of Glasgow coma scale(GCS)-Full Out-line of UnResponsiveness(FOUR)scale(GCS-F)score and arterial lactate level for prognosis of intracerebral hemorrhage(ICH)in elderly patients.Methods A total of 278 elderly ICH patients admitted to Neurosurgical Intensive Care Unit of the Affiliated Hospital of North China Universi-ty of Science and Technology from January 2022 to January 2024 were retrospectively recruited.According score at 90 d after onset,95 of them were assigned into good prognosis group and 183 into poor prognosis group.Basic information,vital signs at admission,pupils,laboratory indica-tors,GCS score and other clinical data were compared between the two groups.Binary logistic re-gression analysis was used to analyze the risk factors of poor prognosis in elderly ICH patients.ROC curve was drawn to analyze the prognostic value of GCS-F score(including eye opening re-sponse and limb movement in GCS,and brainstem response in FOUR scale)combined with lac-tate level in elderly ICH patients.Results Significantly higher blood pressure,elevated levels of blood glucose,creatinine and arterial lactic acid,increased percentages of supratentorial and sub-tentorial bleeding,and larger blood loss,while obviously lower GCS score and GCS-F score were observed in the poor prognosis group than the good prognosis group(P＜0.05,P＜0.01).In the analyses for poor prognosis rate of ICH patients at different levels,the poor prognosis rate of se-vere GCS-F patients was significantly higher than that of patients with same level of GCS score(P＜0.05).Binary logistic regression analysis showed that GPS-F score(OR=1.762,95％CI:1.507-2.061,P=0.000)and arterial lactate level(OR=0.536,95％CI:0.385-0.746,P=0.000)were risk factors for 90-day poor prognosis in elderly ICH patients.ROC curve analysis indicated that the AUC value of arterial lactate,GCS score and GCS-F score in predicting 90-day poor prog-nosis in elderly ICH patients was 0.713(95％CI:0.650-0.775),0.827(95％CI:0.774-0.880)and 0.876(95％CI:0.828-0.925),respectively,and the AUC value of GCS-F score combined with arterial lactic acid was 0.919(95％CI:0.886-0.953),which was significantly higher than that of GCS score,GCS-F score and arterial lactic acid alone(P＜0.01).Conclusion GCS-F score has better performance than GCS score in predicting 90-day poor prognosis in elderly ICH pa-tients,especially for severe patients.The GPS-F score combined with arterial lactate level shows the best predictive effectiveness for elderly ICH patients.

Objective:To investigate the expression and prognostic value of glycolytic metabolism related methyltransferase-like 3 (METTL3) in resectable primary liver cancer.Methods:The METTL3 mRNA expression data, clinicopathological data and prognostic information of 364 patients with primary liver cancer and 50 healthy normal liver tissues were downloaded from the Cancer Genome Atlas (TCGA) database, and gene set enrichment analysis was performed. Then the tissue samples of 239 patients with primary liver cancer who underwent radical hepatectomy in Chongqing Armed Police Corps Hospital from January 2016 to may 2019 were selected. Among them, 110 cases contained matched normal liver tissue adjacent to the cancer. The expression of METTL3 protein was detected by immunohistochemical staining. Kaplan-Meier survival curve was drawn, and log-rank test was used for comparison; Cox proportional hazard model was used to evaluate the risk factors affecting the prognosis in patients with primary liver cancer.Results:TCGA database analysis result showed that the expression level of METTL3 mRNA in liver cancer tissue was significantly higher than that in normal liver tissue: 3.72 (3.19, 4.03) vs. 2.45 (2.11, 2.68), and there was statistical difference ( P = 0.007); Kaplan-Meier survival curve analysis result showed that the median overall survival time and disease-free survival time in patients with high expression of METTL3 mRNA were significantly shorter than those in patients with low expression of METTL3 mRNA (43.0 months vs. 72.0 months and 22.0 months vs. 38.0 months, HR = 1.7 and 1.4, P = 0.002 and 0.024). Gene set enrichment analysis result showed that METTL3 mRNA was related to impaired glucose metabolism. In the clinical sample study, the positive expression rate of METTL3 protein in liver cancer tissue was significantly higher than that in normal liver tissue adjacent to cancer: 54.55% (60/110) vs. 14.55% (16/110), and there was statistical difference ( χ2 = 38.92, P<0.01). Among 239 patients with primary liver cancer, 132 cases (55.23%) had positive expression of METTL3 protein in liver cancer tissue, and 107 cases had negative expression. Compared with METTL3 protein negative patients, METTL3 protein positive patients had higher body mass index; higher TNM stage, BCLC stage and tissue grade; more lesions; larger tumor sizes; more common satellite nodules; higher leukocyte count, platelet count and neutrophil count, and there were statistical differences ( P<0.05 or <0.01). Kaplan-Meier survival curve analysis result showed that the median overall survival time and disease-free survival time in patients with METTL3 protein positive were significantly shorter than those in patients with METTL3 negative (18.0 months vs. 38.0 months and 13.0 months vs. 27.0 months, P<0.01). Univariate and multivariate Cox analysis result showed that METTL3 protein positive in liver cancer tissue was an independent risk factor affecting overall survival time and disease-free survival time ( HR = 1.840 and 2.096, 95% CI 1.298 to 2.608 and 1.469 to 2.991, P<0.01). Conclusions:METTL3 is involved in glycolytic metabolism of primary liver cancer, and can be used as a promising biomarker to evaluate the prognosis of patients with primary liver cancer.

Objective To observe the effect of Tomatis converted auditory training on the executive functioning of breast cancer patients undergoing chemotherapy.Methods Eighty breast cancer patients with the executive dysfunction who were undergoing chemotherapy were divided into a control group and an experimental group,each of 40.The experimental group was given Tomatis high and low frequency auditory training,while the control group was given ordinary music training.The patients in both groups were treated in 4 stages,each of 5 consecutive days with intervals of 21 days.The Chinese Version of the Behavioral Assessment of Dysexecutive Syndrome (BADS) was used to evaluate both groups before and after the intervention,including rule transformation ability,problem solving ability,planning ability,supervising ability and organizing ability.Results After the intervention,the experimental group had a significantly higher average score than before the intervention in the rule-switching card test,the action planning test,the key-finding test,and the modified six-element test.Their average BADS score was also significantly improved.The control group showed a significantly better average score only in the key-finding test and in its average BADS total score.After the intervention,the experimental group had a significantly higher average score than the control group in the rule-switching card test and the action planning and six-element tests.Its average BADS rating was also significantly better.Conclusion Tomatis high and low frequency auditory training can improve the executive function of patients undergoing chemotherapy for breast cancer.Its effect is better than that of ordinary music training.

Objective To observe the effect of TOMATIS auditory training on improving cognitive and post-traumatic stress disorder in patients after breast cancer chemotherapy. Methods Eighty invasive ductal carcinoma of breast cancer patients with cognition and psychological disorders were selected in the breast department of Tangshan People's Hospital from October 2016 to September 2017. All patients were randomly divided into control group ( n=40) and experimental group ( n=40) . The experimental group was given the TOMATIS high and low audio frequency auditory training,and the control group was given ordinary music training. Before and after the intervention, the Chinese version of the Montreal cognitive assessment scale ( MoCA) and the post-traumatic stress disorder scale ( PTSD-SS) were evaluated for both groups of pa-tients. Results After the intervention,the experimental group had significantly higher scores in visual struc-ture skills((3. 83±0. 71)vs(2. 68±0. 57)),executive function ((2. 23±0. 53)vs(1. 55±0. 50)),attention and concentration((1. 55±0. 78)vs(1. 23±0. 53)),language((1. 50±0. 75)vs(1. 08±0. 47)),calculation ((2. 00±0. 60)vs(1. 45±0. 75)),abstract thinking((1. 63±0. 54)vs(1. 00±0. 51)),memory((4. 68± 0. 47)vs(2. 70±0. 72)),directive force((5. 25±0. 54)vs(3. 90±0. 81)) and total score((22. 65±2. 89)vs (15. 58±2. 10))than the control group(all P<0. 05). After intervention,the scores of subjective assessment of traumatic events((2. 60±0. 63)vs(3. 98±0. 62)),repeated recurring experiences((24.05±2.72)vs (26. 70±2. 28)),avoidance symptoms((24. 35±1. 64)vs(26. 40±1. 19)),increased alertness((24. 23± 1. 80)vs(25. 45±1. 20)),impaired social function((7. 28±1. 01)vs(8. 68±0. 66)),and total scores((85. 85±5. 13)vs(94. 63±2. 92)) in the experimental group were significantly lower than those in the control group,and the differences were statistically significant ( all P<0. 01) . Conclusion TOMATIS auditory train-ing can effectively improve the cognitive function and psychological state in breast cancer chemotherapy pa-tients,which is worthy of popularization and application.

Objective To investigate the occurrence of common symptoms in breast cancer patients in different chemotherapy periods and to analyze the relationship with the chemotherapy periods. Methods A total of four hundred and fifty?six breast cancer patients receiving chemotherapy in Tangshan Cancer Hospital from August 2016 to August 2017 were investigated via common symptom questionnaire among breast cancer patients. The results of the investigation were statistically analyzed, and the relationship between chemotherapy related symptoms and chemotherapy periods was analyzed by multiple Logistic regression analysis. Results In terms of the 20 kinds of chemotherapy symptoms, among the patients whose incidence rate was >50％ had 9 kinds of symptoms. Multivariate Logistic regression analysis showed that alopecia (95％ CI=5. 820～562. 784,P=0. 001) ,skin allergy ( 95％ CI=0. 002～0. 157,P<0. 001) ,cancer caused insomnia( 95％ CI=1. 179～25. 638, P=0. 030) ,dry mouth ( 95％ CI=0. 008～0. 470,P=0. 007) ,vaginal dryness or burning heat ( 95％ CI=13. 368～647. 615 P<0. 001) ,oral ulcer ( 95％CI=0. 026～0. 654,P=0. 013) ,abnormal defecation ( 95％ CI=0. 025～0. 749,P=0. 022),memory loss (95％CI=1. 065～19. 415,P=0. 041),distal phalanges numbness (95％ CI=0. 004～0. 421,P=0. 007),poor appetite (95％ CI=1. 189～65. 964,P=0. 033),local skin irritation /ulceration ( 95％ CI=0. 003～0. 143, P<0. 001 ) were associated with the chemotherapy, the difference was statistically significant. The above symptoms can be divided into 3 symptom groups by factor analysis,and they were respectively medicine side effect symptom cluster, neuropsychiatric symptom cluster and mucocutaneous symptom cluster. Conclusion There are many symptom clusters that affect the life and rehabilitation level in patients with breast cancer during chemotherapy, and are closely related with the chemotherap cycle. Doctors should adopt a scientific model of symptom management and take measures to improve the survival state of the patients.

Objective To understand the anxiety among gerontal patients with osteoporosis,and to analyze the correlated factors of the anxiety.Methods The social information of the gerontal patients with osteoporosis were investigated,as well as by SAS for the anxiety,and by NRS,PSQI,AHSMSRS for their pain level,sleep quality and healthy management.Results The incidence rate of anxiety was 20.3%,and the average score was (41 .1 4 ± 9.71 )points.Some factors had influence upon the rate,which included sex,month income,sleep quality,self -care ability,pain level,self -management and exercise.Multivariate logistic regression analysis showed that exercise and pain level were the major risk factors.The differences were statistically significant(t =3.033,2.727,P =0.003, 0.007).Conclusion It's higher that the incidence rate of anxiety among gerontal patients with osteoporosis maybe influenced by species of factors,and the quality of life among them needs to be improved by intervention clinically implicated in those factors.

Objective To investigate the changes in the expression of phosphatidylinositol 3?kinase(PI3?K),mammalian target of rapamycin (mTOR)and Beclin?1 in the hippocampus of normal rats and intermittent hypoxia rats with cerebral ischemia/reperfusion ,so as to explore the role of PI3K/mTOR/autophagy pathway in global cerebral ischemia/reperfusion injury aggravated by intermittent hypoxia. Methods A total of 80 healthy male Wistar rats were randomly divided into sham operation group(SO group,n=20),merely ischemia/reperfusion group(I/R group,n=20),intermittent hypoxia for 7?day ischemia/reperfusion group(IH7+I/R group,n=20),and intermittent hypoxia for 21?day ischemia/reperfusion group(IH21+I/R group,n=20). IH7+I/R group and IH21+I/R group were respectively given intermittent hypoxia for 7 days and 21 days before ischemia/reperfusion. The cerebral ischemia/reperfusion model was established by modified Pulsinelli four?vessel occlusion method. The morpholog?ical changes of nerve cells in hippocampal CA1 region were observed by HE staining and electron microscope. The protein expressions of PI3?K, mTOR and Beclin?1 of nerve cells in hippocampal CA1 region were detected by immunohistochemical staining and RT?PCR. The learning memory capacity of rats were assessed by the Morris water maze test. Results Compared with SO group,I/R group increased the never cells morphology damages,reduced the number of survival neurons,and declined the ability of learning and memory(P<0.05). Immunohistochemistry showed that the number of PI3?K immunoreactive cell,mTOR immunoreactive cell and Beclin?1 immunoreactive cell increased in I/R group compared with S0 group(P<0.05). RT?PCR showed that the expressions of PI3?K,mTOR and Beclin?1 increased in I/R group compared with S0 group(P<0.05). Compared with I/R group,intermittent hypoxia groups increased the never cells morphology damages,decreased the number of survival neu?rons,and declined the ability of learning and memory(P<0.05). Immunohistochemistry showed that the number of PI3?K immunoreactive cell, mTOR immunoreactive cell and Beclin?1 immunoreactive cell increased in IH7+I/R and IH21+I/R groups compared with I/R group(P<0.05). RT?PCR showed that the expressions of PI3?K,mTOR and Beclin?1 increased in IH7+I/R and IH21+I/R groups compared with I/R group(P<0.05),and the changes were more significant in IH21+I/R group(P<0.05). Conclusion Intermittent hypoxia can aggravate neurological injury after ischemia,which is related to PI3K/mTOR/autophagy pathway activation.

Objective To investigate the relationship of extracellular regulated protein kinases activation and neural cells autophagy in rats after subarachnoid hemorrhage.Methods One hundred twenty male SD rats were randomly divided into sham operated group,SAH group,ERK1/2 inhibitor U0126 group,autophagy inducer rapamycin (Rap) group.The animal models were established by injecting the autologous blood into cisterna magna twice.U0126 (5μ g/μL) and Rap (10nmol/μL) were injected into lateral ventricles in U0126 group and Rap group 30min before SAH.The morphology of hippocampal nerve cells were examined by using light microscopy.The expression levels of phosphorylated ERK 1/2 (p-ERK 1/2),ERK 1/2mRNA and autophagy markers (Beclin-1 and Beclin-1 mRNA、LC3-Ⅱ and LC3mRNA) in the hippocampus were detected by using inmunohistochemistry and real-time fluorescence quantitative PCR.Result Compared with sham group,the rate of dead nerve cells,the mRNA levels of ERK1/2,Beclin-1 and LC3 as well as the levels of the p-ERK1/2,Beclin-1 and LC3-Ⅱ increased in SAH group (P＜0.05).Compared with SAH group,the rate of dead nerve cells increased(P＜0.05),the ERK1/2 mRNA,Beclin-1 mRNA and LC3 mRN A,and p-ERK1/2,Beclin-landLC3-Ⅱ in U0126 group decreased(P＜0.05);the rate of dead nerve cells decreased (P＜0.05),the Beclin-1 mRNA and LC3 mRNA,the Beclin-1and LC3-Ⅱ level increased in Rap group(P＜0.05),but ERK 1/2 mRNA and p-ERK 1/2 remained unchanged (P＞0.05).Conclusion Activation of the ERK1/2 signaling pathway after SAH,can induce nerve cells death by increasing Beclin-1 and LC3-Ⅱ expressions.

Objective To explore the mechanism of ischemic postconditioning in relieving cerebral ischemia reperfusion (IR) by regulating autophagy through P38MAPK pathway.Methods Cerebral ischemia reperfusion model was established by using modified Pulsinelli four-vessel occlusion (4-VO).Totally 128 male SD rats were divided into 4 groups randomly:control group (sham),cerebral ischemia reperfusion model group (CIR),cerebral ischemic postconditioning group (CIP),and cerebral ischemic postconditioning + P38MAPK inhibitor group (SB203580 group).Each group was subdivided into four time points:6 h,24 h,48 h,and 72 h.The morphological changes of the hippocampus CA1 area neurons at each time point and the number of surviving nerve cells were detected with HE staining.The expression of the hippocampus CA1 area phosphorylated P38MAPK and the autophagy-related genes of Beclin-1 and LC3-Ⅱ were detected with immunohistochemistry.The protein content of the hippocampus phosphorylated P38MAPK and autophagy-related genes of Beclin-1 and LC3-Ⅱ were detected with Western blotting.Results Compared with those in sham group,the damage of rats' hippocampal neuron structure and the survival rate of neurons at each time point decreased in CIR group,the expressions of p-P38MAPK,LC3-Ⅱ and Beclin-1 increased.Compared with those in CIR group,in CIP and SB203580 groups the structure of rats hippocampal neurons was improved,the survival rate of neurons increased,the expression of p-P38MAPK decreased and the expressions of LC3-Ⅱ and Beclin-1 increased at each time point.Compared with CIP group,SB203580 grouphad improved structure of rats' hippocampal neurons,increased survival rate of neurons,decreased expression of p-P38MAPK,and increased expressions of LC3-Ⅱ and Beclin-1 at each time point.Conclusion Cerebral ischemic postconditioning through inhibiting P38MAPK pathway can regulate autophagy and exert its nerve-protective effect.

Objective To investigate the related factors of anxiety in patients undergoing liver puncture,so as to provide better clinical care and psychological intervention for patients to ensure the successful completion of liver puncture. Methods From January 2008 to January 2014,310 cases of patients from the Third People's Hospital of Shenzhen with liver puncture were selected as the research object. The patients' general condition and self rating Anxiety Scale were investigated. Results The SAS score of the patients who would undergo liver puncture was(47.25±0.44)points,and the incidence of anxiety symptoms was 91.3%. The results of univariate and multivariate analysis showed that the effect of patients with anxiety before liver biopsy can explain the variation of the size of the corresponding factors:whether accompanied by family members, payment methods,awareness of the disease,ear of liver failure,the education level,and gender(β' =0.617, 0.352,0.114,0.102,0.082、0.043;P < 0.05). Conclusions Before the liver puncture,the patients show a state of anxiety. The main factors affecting the anxiety status are whether to have family members,to pay for the disease,to understand the disease,to worry about the failure of liver failure,the degree of education and gender medical staff should provide targeted nursing intervention for patients to alleviate anxiety and promote rehabilitation on the basis of the above factors and the relevant circumstances.