Parkinson's disease(PD)depression is one of the most common non-motor symptoms of PD,but depression is often ignored in the early stages of PD and is not treated in time.With the progression of the disease,the symptoms of depression become more prominent,and patients tend to commit suicide in severe cases,which seriously reduces the quality of life of patients.At present,although there are many clinical treatment methods for PD with depression,but the clinical effect is not clear,and there is still a lack of effective therapeutic intervention means and methods.In this paper,the more common treatment methods are summarized,to develop an individualized treatment plan for PD patients with depression.

This paper reports a pair of siblings with congenital short-bowel syndrome (CSBS) complicated with intestinal malrotation. Case 1 was born with a birth weight of 2 550 g and a length of 48 cm. On September 10, 2017, emergency Ladd's procedure and appendectomy were performed on the infant 23 days after birth due to intestinal obstruction at the Women and Children's Hospital, School of Medicine, Xiamen University. The small intestine of the infant had a total length of 65 cm. Postoperative enteral and parenteral nutrition supports were provided for six months. Whole exome sequencing revealed a homozygous variant (NM 024769; nucleotide deletion in the exon 3-5) in the CLMP gene (chr11:122953792-122955421), with the parents being the heterozygous carriers but without phenotype. Case 2, the younger sibling of Case 1, was born in the same hospital on March 20, 2020, with a birth weight of 2 932 g and a body length of 49 cm. Prenatal single-gene sequencing on the amniotic fluid identified the same gene variation as his sister's. The baby boy received Ladd's procedure and appendectomy on the second day after birth which found the length of his small intestine was 51 cm. Full enteral nutrition was achieved six months after the operation. Both cases were followed up for 12 months. The body weight and length of Case 1 were both below the first percentile (< P1). The body weight of Case 2 was 8.03 kg ( P3- P5) and the length was 76.0 cm ( P25- P50).

Objective: To compare the biomechanical performance between the single- versus double-threaded cannulated screws in the treatment of femoral neck fractures of Pauwels type Ⅲ. Methods: Models of femoral neck fracture of Pauwels type Ⅲ (70°) were made of the Sawbone synthetic composite femurs. All specimens were divided into 2 groups (n=12). Group A was fixated with single-threaded cannulated screws and group B with double-threaded cannulated screws, both in an inverted triangle configuration. The screws ranged from 90 to 95 mm in length and from 7.3 to 7.5 mm in diameter. All the specimens were subjected to axial stiffness and failure load tests with 7° valgus (simulating normal two-legged weight-bearing stance) and 25° valgus (simulating normal one-legged weight-bearing stance) and torsion test as well. The 2 groups were compared in the torques at axial stiffness angles of 1°, 2°, 3°, 5° and 7°. Results: Group B had significantly greater axial stiffness at 7° valgus and 25° valgus (89±26 N/mm and 128±37 N/mm) and failure load (1,154±368 N) than group A did (36±12 N/mm and 47±16 N/mm; 688±94 N) (P< 0.05). The torques increased with the increase in rotation angle in both groups. However, the torques in group B (3.26±0.96, 4.16±1.23, 4.64±1.13, 5.59±1.26 and 6.53±1.47 N·m) were all significantly larger than in group A (1.44±0.19, 2.03±0.41, 2.33±0.62, 2.74±0.87 and 3.05±1.07 N·m) (P<0.05). Conclusion Double-threaded cannulated screws may provide better biomechanical stability than single-threaded ones, due to their substantial improvement in anti-compression and anti-rotation performance.

Objective To investigate the relationship between CYP 2C19 gene polymorphisms and clopidogrel efficacy in coronary heart disease patients after percutaneous coronary intervention (PCI).Methods From January 2016 to December 2017,62 patients with acute coronary syndromes and treated with PCI in Guizhou Aerospace Hospital were recruited, CYP2C19 genotype, ADP －induced platelet aggregation rate and myocardial enzymes and other indicators were detected before operation .The myocardial enzymes were measured 24 hours after PCI.According to different metabolic types,the patients were grouped,the above indicators were compared.Results The CYP2C19*1/*1 was 37.10%,CYP2C19*1/*2 was 35.48%,CYP2C19*1/*3 was 11.29%,CYP2C19*2/*2 was 12.90%,CYP2C19*2/*3 was 3.23% and CYP2C19*3/*3 was 0.00%.The LDH,AST,CK,CK－MB and α－HBDH in the PCI patients after operation were significantly higher than those before operation (t＝0.019,0.040, 0.044,0.022,0.014,all P＜0.05).But ADP induced platelet aggregation rate and myocardial enzymes and other indicators among fast metabolism group,intermediate metabolic group and slow metabolic group had no statistically significant differences (all P ＞0.05).Conclusion CYP2C19 mutation frequency in the Chinese population is relatively large,the sample size of this study is less ,the relationship between clopidogrel resistance and the specific genotype can not be obtained ,it need to increase the sample size and comprehensive multi －factor consideration .

Objective To explore the observation and nursing of traumatic mediastinal hematoma.Methods The clinical data in 44 cases of mediastinal hematoma treated in our department from July 2006 to May 2016 were analyzed retrospectively.Results Forty cases were cured,4 cases(9％) died,the mortality rate was 9％,in which 1 case died from postoperative consumptive coagulopathy,1 case died from acute coronary syndrome and 2 cases died from traumatic hemorrhagic shock.Conclusion Timely diagnosis and treatment of intrathoracic cardiac and vascular injury are the key to save the lives of patients;the nursing focuses include observing the hematoma progress,adopting the comprehensive treatment measures such as controlled hypotension,limited fluid resuscitation and correctly selecting infusion approach for preventing hematoma enlargement and rupture.

Objective To compare patellar ring,Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures.Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016.They were 155 men and 130 women,with an average age of 45.5 years (from 18 to 70 years).Their fractures included 176 transverse,28 longitudinal split and 81 comminuted ones.They were divided into 3 groups according to their different internal fixation methods:patellar ring fixation (98 cases),Kirschner wire tension band (92 cases),patellar ring plus Kirschner wire fixation (95 cases).The 3 groups were compared in terms of operative time,intraoperative bleeding,fracture healing time,knee function by B(o)stman score at the last follow-up and postoperative complications.Results The operative time in the patellar ring group(58.9 ±6.4 min) was significantly shorter than in the Kirschner wire group (71.8 ± 7.8 min) and in the patellar ring plus Kirschner wire group (74.4 ± 8.0 min) (P ＜ 0.05).There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding (P ＞ 0.05).The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0％ (92/92),significantly higher than in the patellar ring group (90.8％,89/98) and in the patellar ring plus Kirschner wire group (91.6％,87/95) (P ＜ 0.017).There was no significant difference in postoperative complication rate between the patellar ring fixation group (2.0％,2/98),Kirschner wire tension band fixation group (1.1％,1/92) and the patellar ring plus Kirschner wire group (2.1％,2/95) (P ＞ 0.05).Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures,showing the advantages of less operative invasion,fewer postoperative complications,better functional recovery of the affected knee joint,and lower price over the other 2 internal fixation methods.

A 68-year-old female patient with multiple fractures of the right distal radius received oral compound codeine phosphate and ibuprofen sustained release tablets(containing ibuprofen 0. 2 g,codeine phosphate 13 mg per tablet)3 tablets twice daily after plaster external fixation. Ten minutes after the first administration,the patient developed wheezing,palpitation,pale,cough,expectoration,nausea,and vomiting. Oxygen inhalation,IV infusion of doxofylline and methylprednisolone sodium succinate for injection,and terbutaline sulphate solution for nebulization and budesonide suspension for inhalation were given immediately. Two hours after treatments,wheezing was relieved and wheezing rales in the lung disappeared. By asking the medical history,it was found that the patient had developed wheezing after taking somedon and was diagnosed as bronchial asthma 1 month ago in another hospital.

A 68-year-old female patient with multiple fractures of the right distal radius received oral compound codeine phosphate and ibuprofen sustained release tablets(containing ibuprofen 0. 2 g,codeine phosphate 13 mg per tablet)3 tablets twice daily after plaster external fixation. Ten minutes after the first administration,the patient developed wheezing,palpitation,pale,cough,expectoration,nausea,and vomiting. Oxygen inhalation,IV infusion of doxofylline and methylprednisolone sodium succinate for injection,and terbutaline sulphate solution for nebulization and budesonide suspension for inhalation were given immediately. Two hours after treatments,wheezing was relieved and wheezing rales in the lung disappeared. By asking the medical history,it was found that the patient had developed wheezing after taking somedon and was diagnosed as bronchial asthma 1 month ago in another hospital.

Objective To investigate the effects of recombinant tissue plasminogen activator (rt-PA)intravenous thrombolysis on blood-brain barrier (BBB) permeability,the expressions and the activities of MMP-2 and MMP-9 after cerebral ischemia in rats.Methods A total of 40 adult male Sprague-Dawley rats were allocated into 3 groups:Sham operation group (n =10),middle cerebral artery occlusion (MCAO) group (n =18),and rt-PA thrombolysis group (n =18).A MCAO model was established by using autologous thromboembolism.The sham operation group did not inject any thromboembolus,the MCAO group only made MCAO,and the rt-PA thrombolysis group received intravenous thrombolysis with rt-PA at 3 hours after MCAO.Brain infarct volume was determined by 2,3,5-triphenyl tetrazolium chloride staining BBB permeability was measured by Evans blue dye leakage.The activities and the expressions of MMP-2 and MMP-9 in brain tissue were detected by Gelatin zymography and Western blot,respectively.Results Compared to the MCAO group,the neurological function was improved significantly in the rt-PA thrombolysis group,and the infarct volume was also reduced significantly (t =7.365,P =0.005).However,the hemorrhage score (t =-3.286,P =0.017) and BBB permeability (t =-3.947,P =0.029) were increased significantly.The activities and the expressions of MMP-2 and MMP-9 in the sham operation group were lower.The activities and the expressions of MMP-2 (t =-45.121,P =0.000; t =-11.624,P=0.000) and MMP-9 (t=-71.849,P=0.000; t=-8.992,P=0.000) in the MCAO group were increased and upregulated significantly.Compared to the MCAO group,the activities and the expressions of MMP-2 (t =-28.792,P =0.000; t =-3.809,P =0.013) and MMP-9 (t =-53.506,P =0.000; t =-2.640,P =0.046) in the rt-PA thrombolysis group were increased and upregulated significantly.Conclusions After rt-PA intravenous thrombolytic therapy,the BBB permeability was increased.The activities and the expressions of MMP-2 and MMP-9 were increased and upregulated.MMP-2 and MMP-9 might participate in the increased BBB permeability,and thus inducing hemorrhagic transformation after rt-PA intravenous thrombolytic therapy in rats with cerebral ischemia.

ObjectiveTo investigate the application of the ratio of early diastolic peak velocity of mitral valve(E) and early diastolic peak velocity of mitral annular(Ea) on evaluating left ventricuiar diastolic function in patients with chronic heart failure.MethodsLeft atrial diameter(LAD),left ventricular end-diastolic diameter (LVEDd),interventricular septal thickness (IVST),left ventricular ejection fraction (LVEF),E and late diastolic peak speed of mitral valve (A) of 30 patients with diastolic heart failure(DHF,DHF group),30 patients with systolic heart failure(SHF,SHF group) and 30 healthy persons (control group) were detected by conventional echocardiography.E/A ratio and E-wave deceleration time (DT) were calculated.Early diastolic peak velocity of longitudinal septal and left ventricular lateral part of mitral annulus (Esep,Elat) were measured by tissue Doppler imaging (TDI).Ea and E/Ea ratio were calculated as well as the relevant analysis was made.Results ( 1 ) LAD and IVST in DHF group were significantly higher than those in control group [(44.90±8.31) mm vs.(30.87±3.48) mm,(9.43±2.18) nn vs.(8.17 ± 1.12)mm,P＜0.05].LVEDd in SHF group was obviously higher than that in control group and DHF group [(66.30 ± 10.21) mm vs.(44.77 ± 4.17) mm,(48.60 ± 8.85) mm,P＜0.05],and LVEF and DT were significantly lower than those in control group and DHF group(P ＜ 0.05 ).(2) Esep,Elat and Ea in DHF and SHF group were significantly lower than those in control group( P ＜ 0.01 ),and E/Esep,E/Elat and E/Ea ratios were obviously higher than those in control group (P ＜ 0.01 ).( 3 ) The level of B type natriuretic peptide (BNP) in DHF and SHF group was significantly higher than that in control group [(477.73 ± 722.76),(978.60 ± 825.04) ng/L vs.(29.23 ± 17.84) ng/L,P ＜ 0.05 ].The level of BNP in SHF group was significantly higher than that in DHF group (P＜0.05 ).(4) Multivariate linear regression analysis showed that NYHA classification and BNP were correlated with E/Ea ratio (P ＜ 0.05).(5) The area under curve (AUC) of E/Ea in diagnosing chronic heart failure was 0.984 (95％ CI:0.000-1.000).AUC of E/Ea in identifying DHF and SHF was 0.857(95％ CI:0.773-0.940).The sensitivity and specificity of E/Ea were much higher than those of E/A.Conclusions Chronic left ventricular systolic insufficiency is commonly combined with different-degree diastolic dysfunction.The evaluation of left ventricular diastolic function can be more simple and accurate combined with pulse wave Doppler and TDI.