Objective To establish a quality control method for Bletilla compound spleen-tonifying Traditional Chinese Medicine(TCM). Methods The content of gallic acid was determined by HPLC. Atractylodes macrocephala Koidz, Codonopsis pilosula Nannf and Pulsatillae Radix were identified by TLC. Results The identification and determination methods showed good specificity. Gallic acid displayed good linearity within the range of 3.6-179.8 µg/ml （r=0.999 9）. The average recovery was 101.12% （RSD 0.98%）. Conclusion The TLC and HPLC could be used as quality control method for Bletilla compound spleen-tonifying TCM.

Objective:To explore the application effect of the multidisciplinary diagnosis and treatment nursing in improving postoperative anxiety and depression and quality of life in patients with lateral skull base tumor, so as to provide a constructive template for the multidisciplinary diagnosis and treatment nursing.Methods:This was a prospective cohort study design. A total of 100 patients who underwent lateral skull base tumor surgery in Shandong Second Provincial General Hospital from January 2021 to April 2022 were selected as the research objects. The patients were divided into observation group and control group by random digits table method with 50 cases in each group. The control group was given routine nursing care after operation of lateral skull base tumor and routine follow-up management. The observation group received the multidisciplinary diagnosis and treatment nursing on the basis of the control group. The intervention time was 3 months. The psychological state and quality of life of the two groups before and after intervention were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form Health Questionnaire (SF-36).Results:There was no significant difference in SAS, SDS, and SF-36 scores before intervention between the two groups ( P>0.05). The scores of SAS, SDS and SF-36 after the intervention were (44.58 ± 5.61), (41.66 ± 8.48), (75.66 ± 13.65) points in the observation group, and (50.86 ± 4.91), (45.80 ± 9.32), (68.43 ± 14.34) points in the control group, there were statistically significant differences between the two groups( t values were -5.95, -2.32, 2.58, all P<0.05). Conclusions:The multidisciplinary diagnosis and treatment nursing can significantly improve anxiety, depression and quality of life of patients with lateral skull base tumor after surgery.

ObjectiveTo explore the effect of home visit based on empowerment education on psychotic symptoms， self-management ability and well-being of schizophrenia patients in home rehabilitation. MethodsA total of 87 cases of schizophrenia patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） and were recovering at home in Caiba town， Yibin city from January to July 2021 were selected by random sampling method as research subjects. They were divided into experimental group （n=43） and control group （n=44） according to the random number table method. The two groups received routine family visits， and the experimental group received family visits based on empowerment education. The intervention cycle of the two groups was 6 months. Before and after the intervention， the severity of psychotic symptoms， self-management ability and well-being of the patients in the two groups were assessed with the Brief Psychiatric Rating Scale （BPRS）， the Schizophrenia Self-Management Instrument Scale （SSMIS） and the Index of Well-Being Scale （IWB）. ResultsAfter intervention， the intra group comparison showed that the BPRS score in the experimental group was lower than that before the intervention （t=4.550， P<0.01）， the SSMIS scores in both groups were higher than those before intervention （t=-17.107， -6.367， P<0.01）， and the IWB score in the experimental group was higher than that before intervention （t=-9.239， P<0.01）. The comparison between groups showed that the BPRS score of the experimental group was lower than that of the control group， and the SSMIS and IWB scores were higher than those of the control group （t=-3.899， 10.564， 9.690， P<0.01）. ConclusionThe implementation of family visit based on empowerment education may help to improve the psychotic symptoms of home rehabilitation schizophrenia， and improve their self-management ability and well-being.

Objective:To establish a nomogram model for predicting the risk of coronary artery disease in elderly patients with acute myocardial infarction (AMI).Methods:The clinical data of elderly patients with AMI who underwent coronary angiography in the department of cardiology of Cangzhou Central Hospital from July 2015 to March 2020 were analyzed, including age, gender, smoking history, underlying diseases, family history, blood pressure, left ventricular ejection fraction (LVEF), and several biochemical indicators at admission, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein [Lp(a)], apolipoproteins (ApoA, ApoB), ApoA/B ratio, total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil), fasting blood glucose (FBG) and uric acid (UA). Patients were divided into model group (2 484 cases) and validation group (683 cases) according to the ratio of 8∶2. According to Gensini score, the model group and validation group were divided into mild lesion group (0-20 points) and severe lesion group (≥81 points). The differences of each index between different coronary lesion degree groups were compared. Lasso regression and Logistic regression were used to analyze the risk factors of aggravating coronary lesion risk in elderly patients with AMI, and then the nomogram prediction model was established for evaluation and external validation.Results:① In the model group, there were significant differences in the family history of coronary heart disease, FBG and HDL-C between the mild lesion group (411 cases) and the severe lesion group (417 cases) [family history of coronary heart disease: 3.6% vs. 7.7%, FBG (mmol/L): 5.88±1.74 vs. 6.43±2.06, HDL-C (mmol/L): 1.48±0.69 vs. 1.28±0.28, all P < 0.05]. In the validation group, there were significant differences between the mild lesion group (153 cases) and the severe lesion group [132 cases; FBG (mmol/L): 5.58±0.88 vs. 6.85±0.79, HDL-C (mmol/L): 1.59±0.32 vs. 1.16±0.21, both P < 0.05]. ② Lasso regression analysis showed that family history of coronary heart disease, FBG, and HDL-C were risk factors of coronary artery disease in elderly patients with AMI, with coefficients 0.118, 0.767, and -0.558, respectively. Logistic regression analysis showed that FBG [odds ratio ( OR) = 1.479, 95% confidence interval (95% CI) was 1.051-2.082, P = 0.025] and HDL-C ( OR = 0.386, 95% CI was 0.270-0.553, P < 0.001] were independent risk factors of coronary artery disease in elderly patients with AMI. ③ According to the rank score of FBG and HDL-C, the nomogram prediction risk model of aggravating coronary artery disease degree was established for each patient. It was concluded that the risk of coronary artery disease in elderly people with higher FBG level and (or) lower HDL-C level was significantly increased. ④ The nomogram model constructed with the model group data predicted the risk concordance index (C-index) was 0.689, and the C-index of the external validation group was 0.709. Conclusions:FBG and HDL-C are independent risk factors for aggravating coronary artery disease in elderly patients with AMI. The nomogram model of aggravating coronary artery disease in elderly patients with AMI has good predictive ability, which can provide more intuitive research methods and clinical value for preventing the aggravation of coronary artery disease in elderly patients.

OBJECTIVE：To systematically e valuate the effectiveness of inhaled corticosteroids combined with tiotropium bromide versus inhaled corticosteroids alone in the treatment of asthmatic-COPD overlap syndrome ，and to provide evidence-based reference for clinical use. METHODS ：Retrieved from PubMed ，Web of Science ，Embase，Cochrane Library ，CBM，CNKI， VIP，Wanfang database ，during the establishment of the database to Nov. 2019，randomized controlled trials （RCT）about inhaled corticosteroids combined with tiotropium bromide （trial group ）versus inhaled corticosteroids alone （control group ）in the treatment of asthmatic-COPD overlap syndrome were collected. After data extraction of included literatures met inclusion criteria ，quality evaluation with modified Jadad scale ，Meta-analysis was performed for response rate ，forced expiratory volume in the first second （FEV1），forced vital capacity （FVC），FEV1/FVC，inspiratory fraction （IC/TLC），residual to total ratio （RV/TLC），asthma symptom（ACT）score，chronic obstructive pulmonary symptom （CAT）score，the times of acute exacerbations by Rev Man 5.3.0 software. RESULTS ：A total of 25 RCTs were included ，involving 2 828 patients. The results of Meta-analysis showed that the response rate [RR ＝1.16，95％CI（1.10，1.22），P＜0.001]，FEV1[MD＝0.44，95％CI（0.35，0.54），P＜0.001]，FVC [MD ＝0.70， 95％CI（0.46，0.95），P＜0.001]，FEV1/FVC [MD= 8.79，95％CI（6.22，11.37），P＜0.001]，IC/TLC [MD ＝4.93，95％CI（3.01， 6.85），P＜0.001]，RV/TLC [MD ＝－9.22，95％CI（－9.79，－8.66），P＜0.001]，ACT score [MD ＝5.38，95％CI（4.30，6.47）， P＜0.001]，CAT score [MD ＝－3.67，95％CI（－4.89，－2.45），P＜0.001] and the times of acute exacerbations [MD ＝－1.49， 95％CI（－2.82，－0.17），P＝0.03] in trial group were significantly higher than control group ，with statistical significance. CONCLUSIONS：Compared with inhaled corticosteroids alone ，inhaled hormone combined with tiotropium bromide can improve the response rate and pulmonary function ，but increase the times of acute exacerbation of patients with asthmatic-COPD overlap syndrome.

Objective:To study the diagnostic value of multimodal ultrasound in thyroid microcarcinoma(TMC).Methods:The clinical data of 203 TMC patients in the Sixth Hospital of Shanxi Medical University from March 2015 to January 2019 were retrospectively analyzed.The preoperative multimodal ultrasound results [high frequency ultrasonography(HFU), color Doppler (DU), ultrasonic elastography (UE)] were collected, the postoperative pathological results were seen as the gold standard, and the consistency of multimodal ultrasound diagnosis and the pathological results was analyzed, the diagnosis effect index of multimodal ultrasound was calculated, ROC curve was used to analyze the diagnostic value of multimodal ultrasound for TMC.Results:The diagnostic results of HFU, UE were highly consistent with the postoperative pathological results (0.80.9). DU had medium diagnostic value for TMC (0.7≤AUC≤0.9).Conclusion:Multimodal ultrasonography has high diagnostic value for TMC, and it can be used in many fields such as clinical diagnosis, efficacy evaluation and reexamination due to its good repeatability and non-invasive.

Objective To investigate the value of intravoxel incoherent motion DWI (IVIM-DWI) in differential diagnosis of high-grade gliomas and brain metastases.Methods Conventional MRI,contrast-enhanced MRI and IVIM-DWI were performed before surgery or chemoradiotherapy in 24 patients with high-grade gliomas and 28 patients with brain metastases.The diffusion constant (D),pseudodiffusion coefficient of perfusion (D*) and the perfusion fraction (f) in the parenchyma and peritumoral edema region within 1 cm and the normal centrum semiovale in the opposite side were measured,then the relative values of all parameters in each region (rD*,rD,rf) were calculated.Independent sample t test was used to analyze the parameters.ROC curve analysis of the parameters statistically different between high grade gliomas and brain metastases were performed,and the diagnostic efficacies were evaluated.Results The D* and rD* values of tumor parenchyma and in peritumoral edema within 1 cm of high-grade gliomas were higher than those of brain metastases (all P＜0.05).The f and rf values of tumor parenchyma and in peritumoral edema within 1 cm of highgrade gliomas were lower than those of brain metastases (all P＜0.01).The AUC of D* value in peritumoral edema within 1 cm was the highest,but there was no statistically different between any two AUC except the rD* value of peritumoral edema within 1 cm (P =0.033).Conclusion IVIM-DWI can distinguish the differences of diffusion and perfusion information in parenchyma and edema area between high-grade gliomas and brain metastases,therefore providing the basis for differential diagnosis of them.

Objective To improve the degree of substitution of the cholesteryl by purifying cholesteryl succinyl ester (CHS) ,one of the raw materials .Methods CHS was purified by recrystallization ,the pure CHS structure was characterizate by differential scanning calorimetry (DSC) and X ray diffraction (XRD) ,the free cholesterol content of the pure and crude were determinated by high performance liquid chromatography (HPLC) ,the degree of substitution of the cholesteryl was determina-ted before and after the purified by 1 H-NMR .Result CHS was purer after recrystallization ,with property of crystal ,which could significantly improve the degree of substitution of the cholesteryl .Conclusion The method of purification was simple and feasible ,which was the basis of improving hydrophobically modified Bletilla striata polysaccharide′s degree of substitution of the cholesteryl .

Objective To examine the relationship between hyperthyroidism and excessive iodine intake from drinking water through epidemiological studies in the iodine excess and the iodine normal villages. Methods Mengzhuang village of Pei county and Xingji village of Pizhou city in Jiangsu province, with median water iodine concentration of 1284.1 μg/L and 77.9 μ/L, respectively,were selected in 2006. Thyroid diseases of all local residents in the two villages were assessed clinically to compare the prevalence and the distribution of hyperthyroidism. Results A total of 17 471 residents were recruited from the iodine excess village, 26 of them were diagnosed with hyperthyroidism. The prevalence of hyperthyroidism was 1.49‰, 0.75‰ (7/9264) in male,2.32‰( 19/8207) in female, and the age-standardized prevalence was 1.48‰. A total of 12 765 residents were recruited from the iodine normal village, among them 27 residents were diagnosed with hyperthyroidism. The prevalence of hyperthyroidism was 2.12‰, 0.96‰(7/6823) in male, 3.26‰(20/5942) in female, and the agestandardized prevalence was 2.02‰. The prevalence and age-standardized prevalence was significantly lower in the iodine excess village than those in the iodine normal village (u = 2.88, 2.89; all P < 0.01). The prevalence of hyperthyroidism was lower among females in the iodine excess village (2.32‰) than that in the iodine normal one (3.37‰, u = 2.89, P < 0.01). Residents aged 20 - 50 years had higher prevalence of hyperthyroidism[(19.36 -38.96 )/10 000]in the two villages. The proportion of Graves diseases was 50.00% (13/26) in the iodine excessvillage, higher than that in the iodine normal village[29.41%(5/17) , χ2 = 5.853, P < 0.01]. Conclusions Chronic excessive iodine intake does not increase the chance of suffering from hyperthyroidism. On the contrary, the prevalence of hyperthyroidism in the iodine excess village decreases significantly compared with that of the iodine normal village. The prevalence is higher among females.

Objective To observe the application of amniotic membrane in conjunctival sac plasty.Methods 24 cases with different eye diseases were performed with conjunctival sac plasty,in which 11 eyes were performed with amniotic membrane transplantation,5 eyes with symblepharon which adhered with cornea or emerged neovascularization were performed with amniotic membrane transplantation and lamellar keratoplasty,other 8 eyes were performed with amniotic membrane transplantation and conjunctival fornixe.They were followed up for 6~12 months.Results There was no inflammation observed after operation.The transplanted amniotic membrane turned transparent and the conjunctiva at sewing location crawled to amnion 10 d after operation.One month later,the neonatal conjunctiva covered transplanting region completely.Among the 24 eyes,9 eyes were healed,13 eyes were improved,and 2 were ineffective.Conclusion Amniotic membrane is a kind of effective material during conjunctival sac plasty for narrow conjunctival sac.