Objective To explore the influencing factors of depression risk in elderly patients with hypertension and construct and validate a nomogram prediction model.Methods A total of 869 elderly patients with hypertension were selected from national survey database of the China Health and Retirement Longitudinal Study(CHARLS)in 2018.Multivariate Logistic regression analysis was used to identify the risk factors for depression in elderly patients with hypertension,and a nomogram prediction model was constructed.The accuracy and effectiveness of the model were validated by the Hosmer-Lemeshow(H-L)goodness-of-fit test,the area under the curve(AUC)of the receiver oper-ating characteristic(ROC)curve,and the calibration curve.Results The incidence of depression in elderly patients with hypertension was 47.18％.Factors influencing the risk of depression included rural residence(OR=2.191,P＜0.05),impaired basic activities of daily living(BADL)(OR=2.338,P＜0.05),impaired instrumental activitiesofdaily living(IADL)(OR=1.674,P＜0.05),poor life satisfaction(OR=7.348,P＜0.05),fair self-rated health(OR=0.441,P＜0.05),good self-rated health(OR=0.259,P＜0.05),and sleep duration of 6 to 9 hours(OR=0.510,P＜0.05).The AUC of the ROC curve was 0.795,the slope of the calibration curve was close to 1,and the H-L goodness-of-fit test yielded x2=5.074.The validation set showed an AUC of 0.703.Conclusion The prediction model established in this study has high accuracy and discriminative ability.Healthcare professionals can take effective preventive measures based on individual patient factors.

The Helicobacter pylori（Hp）infection rate in China has been at a high level.Although the infection rate of Hp in Chinese children has decreased with the development of social economy，drug-resistant strains are constantly emerging due to the wide application of antibiotics in children and so on.The eradication rate of previous Hp eradication programs shows to decline.The eradication treatment of Hp in children is facing great challenges.This article reviews the infection，drug resistance status and treatment progress of Hp in Chinese children，in order to provide the reference for the prevention and eradication treatment of Hp infection in children.

Inflammatory bowel disease(IBD)is a group of chronic non-specific intestinal inflammatory diseases with unclear etiology.Its pathogenesis may be related to the intestinal immune imbalance caused by the interaction of multiple factors such as environment,genetics and intestinal microecology.Macrophages,as an important component of the immune system,can maintain a balance between pro-inflammatory and anti-in-flammatory responses in the intestine.Macrophages can be divided into two polarization types:classical activa-tion(Ml)and alternative activation(M2)according to the different phenotypes and cytokines secreted by macrophages.The polarization of macrophages plays a key role in the subside of intestinal inflammation and the healing of mucosa.In the intestinal immune system of IBD,the imbalance between pro-inflammatory and anti-inflammatory factors caused by macrophage polarization imbalance can lead to sustained progression of intestinal mucosal inflammation and impairment of barrier function,playing a key role in IBD.The changes in macrophage polarization levels may affect the therapeutic effect of IBD.Therefore,targeting macrophage po-larization may be an important target for the treatment of IBD.This article summarizes the role of intestinal macrophage polarization in IBD and the impact of regulating macrophage polarization in IBD treatment to pro-vide reference for studying the new treatment methods for IBD.

Objective:To explore the relationship between depressive symptoms and filial piety in adult-child caregivers of disabled elderly,and the mediating effect of mutuality on the relationship.Methods:Totally 383 adult-child caregivers were assessed with the Center for Epidemiological Studies Depression Scale(CES-D),Dual Filial Piety Scale(DFPS)and Mutuality Scale(MS).The SPSS macro program Process was used to test the mediation model.Results:The CES-D scores were negatively correlated with the reciprocal filial piety scores and the MS scores(r=-0.49,-0.48,Ps＜0.01)and positively correlated with the authoritarian filial piety scores(r=0.37,P＜0.01).The MS scores were positively correlated with the reciprocal filial piety scores(r=0.76,P＜0.01),and negatively correlated with the authoritarian filial piety scores(r=-0.84,P＜0.01).Reciprocal filial piety scores were negatively associated with CES-D scores(β=-0.67).In addition,MS scores partly mediated the relationship between reciprocal filial piety scores and CES-D scores,the value of mediating effect was 22.89％.Conclusion:The depressive symptoms are correlated with filial piety and mutuality among adult-child caregivers of disabled eld-erly.

Objective:To evaluate the potential of 177Lu-prostate specific membrane antigen (PSMA)-3Q in the treatment of metastatic castration-resistant prostate cancer (mCRPC) and compare it with 177Lu-PSMA-I&T. Methods:177Lu-PSMA-3Q was prepared and the quality control and stability testing were performed. Pharmacokinetic evaluation and biodistribution of 177Lu-PSMA-3Q and 177Lu-PSMA-I&T were conducted in normal BALB/c mice and 22Rv1 tumor-bearing mice. SPECT imaging was performed on 2 patients (60 and 76 years old) with mCRPC from Chinese PLA General Hospital at 24, 72, and 120 h after injection of 177Lu-PSMA-3Q or 177Lu-PSMA-I&T ((7.40±0.74) GBq). Data were analyzed by using independent-sample t test. Results:177Lu-PSMA-3Q was prepared with the total activity of 74 GBq, the yield rate of 95% (uncorrected), and the radiochemical purity was still above 95% after 168 h at room temperature. The distribution half-lives of 177Lu-PSMA-3Q and 177Lu-PSMA-I&T were (0.75±0.22) and (0.86±0.19) min, and the clearance half-lives were (24.74±3.77) and (29.53±3.42) min. Biodistribution of normal mice showed that the uptake values in the liver, lungs, and kidneys 5 d after injection of 177Lu-PSMA-3Q were lower than those of 177Lu-PSMA-I&T ( t values: 4.24-8.36, all P<0.05). The tumor uptake of 177Lu-PSMA-3Q after 24 h injection was the highest and was higher than that of 177Lu-PSMA-I&T ((0.856±0.183) vs (0.579±0.126) percentage activity of injection dose per gram of tissue (%ID/g); t=2.78, P=0.024) in 22Rv1 tumor-bearing mice. The rapid clearance pattern resulted in a higher tumor/muscle (T/M) ratio for 177Lu-PSMA-3Q (99.604±11.106), which was significantly higher than that for 177Lu-PSMA-I&T (45.078±10.444; t=7.80, P<0.001). According to SPECT imaging of patients with mCRPC, the residual lesion counts of 177Lu-PSMA-3Q and 177Lu-PSMA-I&T at 120 h accounted for 0.32±0.05 and 0.58±0.04 of those at 24 h, with significant difference ( t=7.62, P=0.002). Conclusion:177Lu-PSMA-3Q is easy to label, and has high yield and radiochemical purity, good stability, excellent biological performance, good targeting ability in patients, longer retention time, and fast background clearance rate, which is an ideal prostate cancer treatment drug targeting PSMA.

AIM:To investigate the effects and possible mechanisms of liraglutide on postopera-tive cognitive function in aged mice.METHODS:C57BL/6J male-aged mice were randomly divided into 4 groups:control group(N group),liraglutide group(L group),model group(M group),and mod-el+liraglutide group(ML group).There were 12 mice in each group.The model was constructed by using sevoflurane anesthesia combined with dis-secting the abdominal cavity in M and ML groups.In L and M groups,liraglutide was injected into the peritoneal cavity at 300 μg/kg,once per day,for 14 days.Postoperatively,the cognitive function of mice was detected by using the open field test,the Y maze experiment,and the conditioned fear ex-periment.Western blotting and ELISA were used to detect the expression of hippocampal glucagon-like peptide-1 receptor(GLP1R),β-arrestin2(β-arres-tin2),stimulator of interferon genes(STING),TANK-binding kinase 1(TBK1),IL-1β,and IL-6;immunoflu-orescence was used to observe the Iba1-positive microglial cell quantity.RESULTS:Compared with N group,M group showed a decrease in the postop-erative spontaneous alternation rate,percentage of freezing time,and GLP1R expression in hippocam-pal tissue(P＜0.05)and an increase in the expres-sion of β-arrestin2,STING,P-TBK1,IL-6,IL-1β,and the number of Iba1-positive cells(P＜0.05).Com-pared with M group,postoperative spontaneous al-ternation rate,percentage of freezing time,and GLP1R expression were increased in ML group(P＜0.05),and the number of β-arrestin2,P-TBK1,IL-6,IL-1β,and Iba1-positive cells was significantly de-creased in ML group(P＜0.05).CONCLUSION:Lira-glutide may ameliorate postoperative cognitive im-pairment in aged mice by inhibiting the β-arrestin2/STING/TBK1 pathway.

AIM:To investigate the effects and possible mechanisms of liraglutide on postopera-tive cognitive function in aged mice.METHODS:C57BL/6J male-aged mice were randomly divided into 4 groups:control group(N group),liraglutide group(L group),model group(M group),and mod-el+liraglutide group(ML group).There were 12 mice in each group.The model was constructed by using sevoflurane anesthesia combined with dis-secting the abdominal cavity in M and ML groups.In L and M groups,liraglutide was injected into the peritoneal cavity at 300 μg/kg,once per day,for 14 days.Postoperatively,the cognitive function of mice was detected by using the open field test,the Y maze experiment,and the conditioned fear ex-periment.Western blotting and ELISA were used to detect the expression of hippocampal glucagon-like peptide-1 receptor(GLP1R),β-arrestin2(β-arres-tin2),stimulator of interferon genes(STING),TANK-binding kinase 1(TBK1),IL-1β,and IL-6;immunoflu-orescence was used to observe the Iba1-positive microglial cell quantity.RESULTS:Compared with N group,M group showed a decrease in the postop-erative spontaneous alternation rate,percentage of freezing time,and GLP1R expression in hippocam-pal tissue(P＜0.05)and an increase in the expres-sion of β-arrestin2,STING,P-TBK1,IL-6,IL-1β,and the number of Iba1-positive cells(P＜0.05).Com-pared with M group,postoperative spontaneous al-ternation rate,percentage of freezing time,and GLP1R expression were increased in ML group(P＜0.05),and the number of β-arrestin2,P-TBK1,IL-6,IL-1β,and Iba1-positive cells was significantly de-creased in ML group(P＜0.05).CONCLUSION:Lira-glutide may ameliorate postoperative cognitive im-pairment in aged mice by inhibiting the β-arrestin2/STING/TBK1 pathway.

Objective:To investigate the role and underlying mechanisms of inhibiting high mobility group box-1 (HMGB1) in the expression of matrix metalloproteinase-9 (MMP-9) in spinal cord astrocytes (AS) in rats after spinal cord injury (SCI).Methods:After an SCI model was established in Sprague-Dawley (SD) rats using a modified Allen's Weight-Dropping method and ethyl pyruvate (EP) or glycyrrhizin (GL) was used to inhibit the effect of HMGB1, the rats were divided into a sham group, an SCI group, an SCI+EP (50 mg/kg) group, and an SCI+GL (100 mg/kg) group. The expression levels of glial fibrillary acid protein (GFAP) and MMP-9 in spinal cord AS were observed. After the spinal cord AS in SD rats was cultured and incubated by the oxygen-glucose deprivation/reoxygenation (OGD/R) procedure, the expression of MMP-9 protein was detected at 6 h/R 6 h, 12 h, 24 h, and 48 h after OGD. The time point with the highest expression was chosen in the subsequent experiments as an OGD/R group. HMGB1 was inhibited by HMGB1 shRNA or EP to observe the effect of HMGB1 on the expression of MMP-9 protein in AS treated with OGD/R. Then, toll-like receptor 4 (TLR4) inhibitor, TIR-domain-containing adaptor inducing interferon- β (TRIF) inhibitor, and nuclear factor-kappa B (NF- κB) inhibitor were used to investigate the effects of TLR4/TRIF/NF- κB signaling pathway during the regulation of HMGB1 on MMP-9 in vitro. Results:Western blot showed that the expression of MMP-9 protein in the spinal cord was significantly increased in rats at 1 d after SCI, and the expression of MMP-9 protein in the SCI+EP group and the SCI+GL group was significantly lower than that in the SCI group ( P<0.001). Immunofluorescence showed that GFAP and MMP-9 proteins were co-localized in the spinal cord after SCI, and the expression of GFAP and MMP-9 proteins in the SCI+EP and SCI+GL groups was significantly lower than that in the SCI group ( P<0.05). Since the expression of MMP-9 protein in the spinal cord AS cultured in vitro was significantly higher in the OGD 6h/R 12h group than that in the normal group and the OGD 6h/R 6h, 24, and 48 h groups, the OGD 6h/R 12h was taken as the OGD/R group. The MMP-9 protein expression in AS in the OGD/R+HMGB1 shRNA group and the OGD/R+EP group was significantly lower than that in the OGD/R group ( P<0.001). In the cultured AS, moreover, inhibiting TLR4, TRIF, and NF- κB reduced MMP-9 protein expression after OGD 6 h/R 12 h when compared with that in the OGD/R group ( P<0.001). Conclusions:HMGB1 inhibition may result in a reduction in MMP-9 expression both in the spinal cord AS in SCI rats and in AS after OGD/R treatment in vitro. HMGB1 may regulate MMP-9 protein expression in AS after OGD/R treatment via the TLR4/TRIF/NF- κB signal pathway.

Objective:To document any effect of clinical rehabilitation pathway management on intubation time, dysfunction and medical expenditure associated with tracheotomy after a stroke.Methods:A total of 154 stroke survivors undergoing tracheotomy were randomly divided into an observation group and a control group, each of 77. Both groups were given routine rehabilitation, while the observation group was additionally provided with clinical rehabilitation pathway management during the rehabilitation intervention. Kaplan-Meier analysis was performed before the experiment and after 2, 4 and 6 weeks of treatment. Clinical pulmonary infection scores (CPISs), scores on the Chelsea Physical Function Assessment Scale (CPAx) and hospitalization cost were compared between the two groups.Results:The median extubation time of the observation group (2d) was significantly shorter than that of the control group (10d). After 2, 4 and 6 weeks of treatment, the average CPIS scores of the observation group were in each case significantly lower than those before treatment and the control group′s averages at the same time points, even though after 4 and 6 weeks of treatment the control group′s average CPIS scores had improved significantly. After 2, 4 and 6 weeks of treatment, the average CPAx scores of the observation group were significantly higher than those before treatment and better than the control group′s averages, even though the control group too had improved significantly compared with before the treatment. Hospitalization days, total hospitalization cost, antibiotic cost and laboratory examination cost of the observation group were, on average, significantly lower than those of the control group.Conclusion:Rehabilitation path management can shorten the period of intubation, prevent pulmonary infections, relieve dysfunction, and reduce medical expenses for stroke survivors after a tracheotomy. It is worthy of clinical promotion.

Objective:To investigate the ethics and existing problems of experimental animals in medical experiments and experimental teaching, and to formulate countermeasures so that animal ethics and animal welfare can be truly reflected in medical experiments.Methods:In this study, a "Basic Function Experiment Center Animal Experiment Questionnaire" with 25 questions was formulated from three aspects: the ethical cognition of experimental animals, whether animal experiments are ethical or not, how to view the problems of animal ethics and experimental teaching and the cognition of virtual simulation experiment teaching. Questionnaire was sent to Hubei University of Medicine to investigate the international students of Batch 2017 (5-year program), undergraduates of Batch 2017 (5-year program) and nursing students of Batch 2018 (4-year program) as well as teachers, researchers and employees of laboratory animal center (all with bachelor degree or above). The survey results were expressed as percentage.Results:The recovery rate of the questionnaire in this study was 98.04%(2 451/2 500), among which the practitioners, teachers and researchers in the laboratory animal center clearly understood the ethics of experimental animals, but there was a widespread phenomenon of lagging ethics among the students. For example, 16.24% (398/2 451) students had not received animal experiment ethics education and training, 29.46% (722/2 451) were not clear about animal protection laws and regulations, 7.14% (175/2 451) thought animal experiments were immoral; 29.54% (724/2 451) had vague cognition of animal welfare and ethical knowledge; 25.91% (635/2 451) were not familiar with the operation steps; 9.38% (230/2 451) were indifferent to the extra treatment of animals due to operation errors, 7.83% (192/2 451) chose to give up the experiment in the treatment of animals after massive bleeding, only 5.43% (133/2 451) chose to continue the experiment after timely hemostasis and infusion, and 9.26% (227/2 451) chose to do operations unrelated to the experiment. After the experiment, 2.28% (56/2 451) chose to kill the animals by bloodletting, only 5.51% (135/2 451) chose excessive anesthesia euthanasia, and 1.96% (48/2 451) chose to kill the animals by cervical dislocation and violence. Only 15.79% (387/2 451) chose to remember the dead animal for 2 minutes. Only 32.56%(798/2 451) of the respondents understood virtual simulation experiment, 34.92% (856/2 451) of the respondents thought that virtual simulation experiment or experimental teaching video could be used to replace the existing live animal experiment, 77.56% (1 901/2 451) believed that the construction of virtual simulation laboratory should be strengthened.Conclusion:It is imperative to strengthen the education of students' ethics of experimental animals, which is conducive to the establishment of correct ethics of experimental animals for medical students, so that the "3R" principle and animal welfare can be truly implemented in experimental teaching and scientific research experiments.