Objective:To explore the value of immature platelets and thromboelastography (TEG) in evaluating bleeding tendency in patients bitten by blood venomous snakes.Methods:In December 2023, a bleeding scoring system was used to grade the bleeding score and degree of bleeding in 147 patients with blood venomous snake bites. Immature platelets and TEG were also tested to analyze the correlation between the bleeding degree of patients and indicators such as TEG, immature platelet ratio (IPF), and absolute value of immature platelets (A-IPF). The measurement data were represented by Mean±SD, and ANOVA was used for comparison among groups. Statistical data were analyzed using χ2 test. Spearman correlation was used to analyze the correlation between bleeding degree and the platelet count (PLT), immature platelet and TEG. Pearson linear correlation was used to analyze the correlation of PLT, immature platelets and TEG. The indexes of immature platelets and TEG were analyzed by receiver operating characteristic curve. Results:The 147 patients were graded for bleeding severity based on their bleeding scores, and divided into mild (22 cases), moderate (119 cases), and severe groups (6 cases), and the clinical data such as age, gender and the time from bite to visit were compared among the three groups. The differences were not statistically significant ( P>0.05). The coagulation reaction time (R), clot formation time (K), and immature platelet parameters (IPF, A-IPF) in TEG parameters increased with the degree of bleeding. PLT decreased with the degree of bleeding, and the difference was statistically significant ( P<0.05). Blood venomous snake bite patients have a negative correlation between PLT and IPF ( r=-0.301, P=0.012), but no correlation with A-IPF ( r=0.072, P=0.461) ; PLT was positively correlated with coagulation Angle (αAngle) and maximum thrombus amplitude (MA) of TEG ( r=0.220、0.243, P=0.028、0.015), but negatively correlated with R value and K value ( r=-0.368、-0.362, P<0.001). IPF is positively correlated with R and K values ( r=303、271, P=0.0020、0.035) ; IPF is not correlated with MA value and Angle angle, while A-IPF is positively correlated with R value ( r=0.162, P<0.001). The degree of bleeding in patients is positively correlated with R value ( r=0.237, P<0.001), but not with K value, MA value, and Angle angle ( P>0.05) ; The degree of bleeding in patients is correlated with PLT ( r=-0.411, P<0.001). The ROC curve analysis results show that the R value, K value, and MA value are effective in evaluating the bleeding risk of blood venomous snake bites in patients, and the PLT combined with A-IPF has the best efficacy in evaluating the bleeding risk of blood venomous snake bites in patients. Conclusion:The combination of PLT and A-IPF, TEG's R value, K value, MA value indicators can accurately evaluate the bleeding risk of blood venomous snake bites, and can be widely used in clinical practice as an important prediction method for bleeding tendency in patients bitten by blood venomous snakes.

Objective:To explore the value of immature platelets and thromboelastography (TEG) in evaluating bleeding tendency in patients bitten by blood venomous snakes.Methods:In December 2023, a bleeding scoring system was used to grade the bleeding score and degree of bleeding in 147 patients with blood venomous snake bites. Immature platelets and TEG were also tested to analyze the correlation between the bleeding degree of patients and indicators such as TEG, immature platelet ratio (IPF), and absolute value of immature platelets (A-IPF). The measurement data were represented by Mean±SD, and ANOVA was used for comparison among groups. Statistical data were analyzed using χ2 test. Spearman correlation was used to analyze the correlation between bleeding degree and the platelet count (PLT), immature platelet and TEG. Pearson linear correlation was used to analyze the correlation of PLT, immature platelets and TEG. The indexes of immature platelets and TEG were analyzed by receiver operating characteristic curve. Results:The 147 patients were graded for bleeding severity based on their bleeding scores, and divided into mild (22 cases), moderate (119 cases), and severe groups (6 cases), and the clinical data such as age, gender and the time from bite to visit were compared among the three groups. The differences were not statistically significant ( P>0.05). The coagulation reaction time (R), clot formation time (K), and immature platelet parameters (IPF, A-IPF) in TEG parameters increased with the degree of bleeding. PLT decreased with the degree of bleeding, and the difference was statistically significant ( P<0.05). Blood venomous snake bite patients have a negative correlation between PLT and IPF ( r=-0.301, P=0.012), but no correlation with A-IPF ( r=0.072, P=0.461) ; PLT was positively correlated with coagulation Angle (αAngle) and maximum thrombus amplitude (MA) of TEG ( r=0.220、0.243, P=0.028、0.015), but negatively correlated with R value and K value ( r=-0.368、-0.362, P<0.001). IPF is positively correlated with R and K values ( r=303、271, P=0.0020、0.035) ; IPF is not correlated with MA value and Angle angle, while A-IPF is positively correlated with R value ( r=0.162, P<0.001). The degree of bleeding in patients is positively correlated with R value ( r=0.237, P<0.001), but not with K value, MA value, and Angle angle ( P>0.05) ; The degree of bleeding in patients is correlated with PLT ( r=-0.411, P<0.001). The ROC curve analysis results show that the R value, K value, and MA value are effective in evaluating the bleeding risk of blood venomous snake bites in patients, and the PLT combined with A-IPF has the best efficacy in evaluating the bleeding risk of blood venomous snake bites in patients. Conclusion:The combination of PLT and A-IPF, TEG's R value, K value, MA value indicators can accurately evaluate the bleeding risk of blood venomous snake bites, and can be widely used in clinical practice as an important prediction method for bleeding tendency in patients bitten by blood venomous snakes.

AIM:To explore the therapeutic effect and possible molecular mechanisms of prednisone combined with icariin(ICA)on hormone resistant nephrotic syndrome(SRNS).METHODS:In the in vi-vo experiment,rats were divided into control group,SRNS group,prednisone group,and P+I group.Each group was given corresponding drugs for 6 weeks.Detection of 24-hour urinary protein in rats using CBB;The blood biochemistry analyzer de-tects rat albumin,total cholesterol,triglycerides,creatinine,and urea nitrogen;HE and Masson were used to detect morphological changes in rat kidney tissue;Immunohistochemical detection of GR-α,GR-β,NLRP3,caspase-1,GSDMD,IL-1β.In the in vi-tro experiment,HK-2 cell injury model with doxoru-bicin,divided into control group,SRNS group,pred-nisone group,P+l group.GR-α,GR-β,NLRP3,cas-pase-1,GSDMD were detected by Rt-PCR and West-ern blot.RESULTS:In the in vivo experiment,com-pared with the control group,the SRNS group showed weight loss,increased 24-hour urine pro-tein,decreased albumin,increased total cholester-ol,triglycerides,creatinine,and urea nitrogen,renal tubular atrophy,increased renal interstitial area,sig-nificant infiltration of inflammatory cells,fibrous tis-sue proliferation,and GR-β,NLRP3,caspase-1,GSD-MD,IL-1 β in renal tissue decreased(P＜0.01);Com-pared with the SRNS group,the combined group showed weight gain,decreased 24-hour urine pro-tein,increased albumin,decreased total cholester-ol,triglycerides,creatinine,and urea nitrogen,re-duced renal tubular atrophy,reduced interstitial in-flammatory cell infiltration,reduced fibrosis,and and GR-α,NLRP3,caspase-1,GSDMD in renal tissue decreased increased(P＜0.01).In vitro experiments,compared with the control group,the model group showed GR-β,NLRP3,caspase-1,and GSDMD in-creased(P＜0.01),GR-α decreased(P＜0.01);Com-pared with the SRNS group,GR-β,NLRP3,caspase-1,and GSDMD decreased(P＜0.01),GR-α increased in the P+I group.CONCLUSION:The combination of prednisone and ICA has a protective effect on the kidneys of SRNS rats and can improve the therapeu-tic effect.The mechanism may be related to the NL-RP3/Caspase-1/GSDMD pathway.

Objective:To study the effect of cognitive behavioral therapy on insomnia (CBT-i) for patients with insomnia and patients with comorbid depressive disorder.Methods:According to the score of Beck Depression Inventory (BDI), 71 patients who met the diagnosis of insomnia were divided into the insomnia group (<14 points, 33 cases) and the insomnia with depression group (≥14 points, 38 cases). Patients in both groups filled in sleep diaries every day and were given standard CBT-i treatment for 8 weeks. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), BDI, Beck Anxiety Inventory (BAI), and the SF-36 Health Survey were evaluated before treatment (baseline), at 4 weeks, 8 weeks, 4 weeks after treatment (3 months), and 16 weeks after treatment (6 months). Independent sample t test was utilized to compare difference between two groups, while repeated measures ANOVA was adopted to analyze data at different timepoints. Results:Compared with baseline assessment, both insomnia group and insomnia with depression group showed significant differences in Sleep Onset Latency (SOL), Sleep Efficiency (SE), PSQI, ISI, BDI, BAI, and SF-36. There were no significant difference between the two groups, at baseline, 8 weeks, 3 months and 6 months in SOL, and SE, however, significant difference was found in the scores of BAI ( t=-6.340,-3.301,-3.511,-2.982), and SF-36 ( t=4.162,3.195,2.022,3.629; P<0.01 or 0.05). In the meantime, there was a significant difference on PSQI and ISI at 8 weeks and 3 months, while there was no significant difference of them at month 6 (7.3±4.6 vs. 4.7±3.4, t=-2.044, P=0.048) . There were no statistically significant differences in sleep latency, sleep efficiency and PSQI scores between the insomnia group and the insomnia with depression group at 8 weeks, 3 months and 6 months. However, compared with baseline measurement, the two groups showed statistically significant differences on BAI and BDI scores at week 8, month 3 and month 6 (all P<0.01). Conclusions:CBT-i is effective for patients with insomnia as well as those with comorbid depression, it could be helpful to alleviate the depressive symptoms and improve patient′s quality of life.

Objective:To study the effect of cognitive behavioral therapy on insomnia (CBT-i) for patients with insomnia and patients with comorbid depressive disorder.Methods:According to the score of Beck Depression Inventory (BDI), 71 patients who met the diagnosis of insomnia were divided into the insomnia group (<14 points, 33 cases) and the insomnia with depression group (≥14 points, 38 cases). Patients in both groups filled in sleep diaries every day and were given standard CBT-i treatment for 8 weeks. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), BDI, Beck Anxiety Inventory (BAI), and the SF-36 Health Survey were evaluated before treatment (baseline), at 4 weeks, 8 weeks, 4 weeks after treatment (3 months), and 16 weeks after treatment (6 months). Independent sample t test was utilized to compare difference between two groups, while repeated measures ANOVA was adopted to analyze data at different timepoints. Results:Compared with baseline assessment, both insomnia group and insomnia with depression group showed significant differences in Sleep Onset Latency (SOL), Sleep Efficiency (SE), PSQI, ISI, BDI, BAI, and SF-36. There were no significant difference between the two groups, at baseline, 8 weeks, 3 months and 6 months in SOL, and SE, however, significant difference was found in the scores of BAI ( t=-6.340,-3.301,-3.511,-2.982), and SF-36 ( t=4.162,3.195,2.022,3.629; P<0.01 or 0.05). In the meantime, there was a significant difference on PSQI and ISI at 8 weeks and 3 months, while there was no significant difference of them at month 6 (7.3±4.6 vs. 4.7±3.4, t=-2.044, P=0.048) . There were no statistically significant differences in sleep latency, sleep efficiency and PSQI scores between the insomnia group and the insomnia with depression group at 8 weeks, 3 months and 6 months. However, compared with baseline measurement, the two groups showed statistically significant differences on BAI and BDI scores at week 8, month 3 and month 6 (all P<0.01). Conclusions:CBT-i is effective for patients with insomnia as well as those with comorbid depression, it could be helpful to alleviate the depressive symptoms and improve patient′s quality of life.

Objective To investigate the efficacy of cognitive-behavioral therapy for insomnia (CBT-i) or combination with tapered hypnotic agents. Methods Seventy-five patients were randomized into either CBT-i group (n=37) or combination group (n=38). The duration of treatment lasted for 8 weeks. The efficacy was evaluated by Pittsburgh sleep quality index (PSQI),Beck depression index (BDI),Beck anxiety inventory(BAI) and sleep diary variables at baseline, middle and end of treatment. Results (1)Compared with the results at baseline, the total scores of PSQI,BDI and BAI in both groups significantly decreased at the end of treatment: CBT-i group, PSQI (4.7±2.5) vs. (12.9±3.5); BDI (3.2±4.4) vs. (9.7±6.4); BAI (4.2±5.6) vs. (10.7±8.1); and combination group, PSQI (5.8±2.8) vs. (13.9±3.1); BDI (4.5±4.8) vs. (13.8±8.7); BAI (4.4±4.0) vs. (14.1±6.3) (all P<0.01). (2) Compared with the results at baseline, subjective sleep quality (SQ), sleep onset latency (SOL), sleep efficiency (SE), sleep disturbance (SD) and used sleep medication (USM) in PSQI in combination group significantly decreased at week 4 and 8 (all P<0.05). The total sleep time (TST) and daytime dysfunction (DF) in PSQI significantly decreased at week 8 (both P<0.05). (3) Compared with combination group, improvement of SOL and SE in CBT-i group was superior (both P=0.01). Conclusions CBT-i for chronic insomnia is effective in both CBT-i alone and combination with tapered hypnotic agents. CBT-i group is superior in improving SOL and SE. Combination regimen in our study can significantly reduce the doses of medication.

Objectives To evaluate the effectiveness of cognitive behavior therapy for insomnia (CBT-i) in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters. Methods Patients who met the diagnostic criteria of chronic insomnia, were divided into primary group or comorbid group. Both groups received standard CBT-i interventions. Psychological scales and sleep diaries were used to evaluate participants' severity of insomnia and psychological conditions related to insomnia at four time points:before intervention (baseline), immediate after intervention, 4 weeks and 16 weeks after intervention. Results Both groups achieved significant improvements after intervention on psychological measurements and sleep diary parameters. Such improvements were maintained at 4-week and 16-week follow-ups. The sleep diary data indicated that by the end of the intervention, there were significant differences on sleep onset latency(51.72 min to 10.53 min in primary group, P<0.01;59.26 min to 15.67min in comorbid group, P<0.01)and sleep efficiency (71％to 95％in primary group, P<0.01;68％to 90％in comorbid group, P<0.01). There were differences on sleep onset latency (10.00 min vs. 13.93 min,P<0.05), total sleep time (355.71 min vs. 327.85 min, P<0.05) and sleep efficiency (95％vs. 91％, P<0.01) in primary group and comorbid group respectively. No differences were found on wake after sleep onset in the two groups. Conclusions Chronic insomnia patients with or without comorbidities both have improvements after CBT-i. Sleep diary parameters rather than psychological measurements are different in two groups. Thus, CBT-i is an effective non-pharmaceutical therapy inpatients with chronic insomnia.

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