ObjectiveTo explore the relationship between negative life events and depression severity in adolescent patients with depressive disorder， as well as the chain mediating role of insomnia symptoms and quality of life. Methods374 outpatient patients and hospitalized patients with adolescent depressive disorders were enrolled. The Adolescent Life Event Scale （ASLEC）， the Insomnia Severity Index （ISI）， the World Health Organization Quality of Life Questionnaire Short Form （WHOQOL-BREF）， and the Center for Epidemiology Depression Scale （CES-D） were used to evaluate the negative life event situation， insomnia symptoms， quality of life level and depression severity of the subjects， respectively. In addition， the PROCESS 4.0 macroprogram was used to analyze the chain mediating effect of insomnia symptoms and quality of life between negative life events and depression severity in patients with adolescent depressive disorder. ResultsThe results of correlation analysis showed that there was a significant correlation between negative life events and insomnia symptoms， quality of life， and depression severity （all P<0.05）. In addition， the results of chain mediation showed that negative life events had a significant direct effect on depression severity， with an effect size of 0.12 （P<0.001）. Insomnia symptoms and quality of life played a mediating role in the relationship between negative life events and depression severity in patients with adolescent depressive disorders， with indirect effect sizes of 0.062 （95%CI： 0.040-0.087） and 0.091 （95%CI： 0.059-0.123）， respectively. It could also play a chain mediation role， and the effect size was 0.039 （95%CI： 0.024-0.057）. ConclusionNegative life events experienced by patients with adolescent depressive disorder not only directly affect the severity of depressive symptoms， but may also indirectly exacerbate depression through insomnia symptoms and quality of life.

Objective: To investigate associations of suicidal ideation with clinical features, inflammatory markers, and thyroid hormones in patients with schizophrenia. Methods: The subjects of this study were 203 schizophrenic patients, grouped on the basis of suicidal ideation. Clinical characteristics were assessed using multiple scales. Neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), monocyte to lymphocyte ratio(MLR) and thyroid hormones were also detected. SPSS 23.0 was used for statistical analyses. Results : The prevalence of suicidal ideation was 21.7% in patients with schizophrenia. Logistic stepwise regression analyses showed that Calgary depression scale(CDSS) total score(OR=1.490, 95%CI=1.287-1.724,P<0.001), insomnia severity index scale(ISI) total score(OR=1.096, 95%CI=1.011-1.187,P=0.025), modified overt aggression scale(MOAS) total score(OR=1.111, 95%CI=1.016-1.215,P=0.021), MLR(Ln)(OR=15.123, 95%CI=3.868-59.125,P<0.001), and triiodothyronine(T3)(OR=0.037, 95%CI=0.003-0.388,P=0.006) were the independent influences of suicidal ideation. Additionally, receiver operating characteristic(ROC) curve analyses revealed that the five-item combination of CDSS total score, ISI total score, MOAS total score, MLR(Ln), and T3(AUC=0.908, 95%CI=0.867-0.949,P<0.001) had better ability to identify suicidal ideation. Conclusion The risk of suicidal ideation is relatively high in patients with schizophrenia, and there may be stronger associations between suicidal ideation and depression, insomnia, aggression, MLR, and T3.

Objective: To understand the influence of junior middle school students health literacy on knowledge, belief and behavior of COVID-19 in rural areas of Jiangxi Province, and to enhance junior middle school students ability to deal with public health emergencies. Methods: Stratified cluster random sampling was used to investigate the health literacy, knowledge level and behavior of COVID-19 protection of 4 311 grade 7 to grade 8 students in rural areas of Jiangxi Province; Chi square test and Logistic regression analysis were used to analyze the correlation between junior high school students health literacy and COVID-19 protection knowledge, belief and behavior. Results: The rate of health literacy of junior middle school students in rural areas was 18.21 %( n =785), the reported rate of intermediate level was high ( n =2 454, 56.92%), and the reported rate of junior high school students at a low level of health literacy was 24.87%( n =1 072). The rate of junior middle school students in rural areas with good COVID-19 protection knowledge was 63.49%, the rate of positive protection attitude was 74.25%, and the rate of good protection behavior was 85.36%; Rate of COVID-19 protection knowledge ( OR=4.85, 95%CI =3.80-6.18) and positive rate of protection attitude of high level health literacy ( OR=44.07, 95%CI =24.57-79.05), protective behavior possession rate ( OR=25.99, 95%CI = 19.67-34.35) were higher than those with low level of health literacy( P <0.01). Conclusion Health literacy is associated with COVID-19 protection knowledge, belief and behavior in rural junior high school students of Jiangxi Province, the findings provide direction for junior middle school students to improve their ability to deal with public health emergencies.

Two Hofmann-Martius-like rearrangement products generated in the production of duloxetine hydrochloride were studied. The structures and generation mechanism of the two Hofmann-Martius rearrangement products were analyzed by LC-MS and NMR. The results showed that under the acidic conditions, the naphthol ether bond of duloxetine would break down and the intermediates of naphthol and the alkyl thiophene cation was generated; the two Hofmann-Martius-like rearrangement products were proven to be a pair of isomers produced by nucleophilic substitution between the naphthol intermediate state and the alkyl thiophene cation intermediate state at the ortho or the para position, respectively. The production of two isomers was related to the strong acidic and protic solvent environment. Therefore, in the salting process of duloxetine hydrochloride, the pH value should be controlled in the range of 3-7 and temperature should be maintained below 50 °C, as well as the nonprotic solvent acetone is chosen to avoid generation of the two isomers.

Objective To analyze the epidemiological characteristics of elderly hospitalized patients with bronchial asthma in Northern Theater Command General Hospital, and to provide reference for the prevention and treatment of elderly hospitalized bronchial asthma. Methods Clinical data of 724 hospitalized patients with bronchial asthma in Northern Theater Command General Hospital were retrospectively analyzed, and general data of 724 patients with bronchial asthma were collected. According to the age of the patients, they were divided into the elderly group (≥60 years old, n=308) and the non-elderly group (< 60 years old, n=416) for analysis and comparison. Multivariate logistic regression was used to analyze the influencing factors of asthma control and attack severity in the elderly. Results There were 308 elderly patients, including 128 males (41.56%) and 180 females (58.44%). The control of asthma was good in 108 cases (35.06%), general in 136 cases (44.16%) and poor in 28 cases (9.09%). The severity of asthma attack was mild in 16 cases (51.95%), moderate in 184 cases (59.74%), severe in 92 cases (29.87%), and critical in 0 cases (0.00%). There were 416 non-elderly patients, including 224 males (53.85%) and 192 females (46.15%). The asthma control in the non-elderly patients was good in 40 cases (9.62%), general in 140 cases (33.65%), and poor in 132 cases (31.73%). The severity of asthma attack was mild in 100 cases (24.04%), moderate in 208 cases (50.00%), severe in 72 cases (17.31%), and critical in 4 cases (0.96%). There were statistically significant differences between the two groups in gender, smoking status, obesity, education level, basic diseases, asthma control and asthma attack severity (P<0.05). The average age, average hospitalization cost, average length of stay and average course of disease in the elderly group were significantly higher than those in the non-elderly group (P<0.05). Logistic regression analysis showed that age, obesity, and education level were independent risk factors for asthma control (P<0.05). Conclusion The prevalence of elderly asthma patients in Northern Theater Command General Hospital region is high and the condition control is general. Age is an independent risk factor affecting the control of the disease condition and the severity of attacks in elderly asthma patients. In addition, obesity and education level are independent risk factors affecting the control of asthma in elderly patients.

Objective:To discuss the mechanism of the high risk factors for hemorrhage by the study on the combination of warfa-rin and magnesium valproate to provide reference for the rational drug selection. Methods:Clinical pharmacists analyzed and adjusted the antiepileptic drug treatment scheme for one patient with cerebral hemorrhage induced by the combination of warfarin and magnesium valproate after mitral valve replacement complicated with epilepsy.The adjusted scheme was as follows:magnesium valproate was sus-pended,0.25 g levetiracetam was used,po,bid,and then the dose was raised to 0.5 g after 14 days for the anti-epileptic treatment. Pharmaceutical care was performed during the whole process of the treatment. Results: After 20-day hospital stay, the international normalized ratio (INR) was controlled within the range of 2.5-3.0,and the patient was discharged in stable conditions with no occur-rence of epilepsy. Conclusion:Levetiracetam has few interactions with warfarin,suggusting the combination is reasonable.

Purpose:Taking tuberculosis as an example, this paper aims at to analyzing the level of reimburse-ment for infectious diseases care, and clarifying the government responsibility. Methods:In order to achieve the ob-jective of this research, UHC framework was used to analyze the security level. Result:The findings of this research reveal that TB in-patients' Compensation Ratio of the New Cooperative Medical Scheme ( NCMS) was lower than aver-age level of all the NCMS patients, the out-patients' was even lower. The categories of anti-tuberculotic for free was limited, the utilization was not as expected. Medical assistance covered few people in spite of its high level of reim-bursement. Conclusion:Based on the findings of this review, it has been revealed that the medical insurance didn't make a big difference in financial protection for patients with infectious diseases. As the treatment for of infectious diseases is a quasi-public good, the government has to shoulder the responsibility of improving the compensation ratio of the patients.