ObjectiveTo investigate the mechanism of action of Kaixinsan in the treatment of Alzheimer's disease （AD） based on network pharmacology， molecular docking， and animal experimental validation. MethodsThe Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） and the Encyclopedia of Traditional Chinese Medicine（ETCM） databases were used to obtain the active ingredients and targets of Kaixinsan. GeneCards， Online Mendelian Inheritance in Man（OMIM）， TTD， PharmGKB， and DrugBank databases were used to obtain the relevant targets of AD. The intersection （common targets） of the active ingredient targets of Kaixinsan and the relevant targets of AD was taken， and the network interaction analysis of the common targets was carried out in the STRING database to construct a protein-protein interaction（PPI） network. The CytoNCA plugin within Cytoscape was used to screen out the core targets， and the Metascape platform was used to perform gene ontology（GO） functional enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis. The “drug-active ingredient-target” interaction network was constructed with the help of Cytoscape 3.8.2， and AutoDock Vina was used for molecular docking. Scopolamine （SCOP） was utilized for modeling and injected intraperitoneally once daily. Thirty-two male C57/BL6 mice were randomly divided into blank control （CON） group （0.9% NaCl， n=8）， model （SCOP） group （3 mg·kg^-1·d^-1， n=8）， positive control group （3 mg·kg^-1·d^-1 of SCOP+3 mg·kg^-1·d^-1 of Donepezil， n=8）， and Kaixinsan group （3 mg·kg^-1·d^-1 of SCOP+6.5 g·kg^-1·d^-1 of Kaixinsan， n=8）. Mice in each group were administered with 0.9% NaCl， Kaixinsan， or Donepezil by gavage twice a day for 14 days. Morris water maze experiment was used to observe the learning memory ability of mice. Hematoxylin-eosin （HE） staining method was used to observe the pathological changes in the CA1 area of the mouse hippocampus. Enzyme linked immunosorbent assay（ELISA） was used to determine the serum acetylcholine （ACh） and acetylcholinesterase （AChE） contents of mice. Western blot method was used to detect the protein expression levels of signal transducer and activator of transcription 3（STAT3） and nuclear transcription factor（NF）-κB p65 in the hippocampus of mice. ResultsA total of 73 active ingredients of Kaixinsan were obtained， and 578 potential targets （common targets） of Kaixinsan for the treatment of AD were screened out. Key active ingredients included kaempferol， gijugliflozin， etc.. Potential core targets were STAT3， NF-κB p65， et al. GO functional enrichment analysis obtained 3 124 biological functions， 254 cellular building blocks， and 461 molecular functions. KEGG pathway enrichment obtained 248 pathways， mainly involving cancer-related pathways， TRP pathway， cyclic adenosine monophosphate（cAMP） pathway， and NF-κB pathway. Molecular docking showed that the binding of the key active ingredients to the target targets was more stable. Morris water maze experiment indicated that Kaixinsan could improve the learning memory ability of SCOP-induced mice. HE staining and ELISA results showed that Kaixinsan had an ameliorating effect on central nerve injury in mice. Western blot test indicated that Kaixinsan had a down-regulating effect on the levels of NF-κB p65 phosphorylation and STAT3 phosphorylation in the hippocampal tissue of mice in the SCOP model. ConclusionKaixinsan can improve the cognitive impairment function in SCOP model mice and may reduce hippocampal neuronal damage and thus play a therapeutic role in the treatment of AD by regulating NF-κB p65， STAT3， and other targets involved in the NF-κB signaling pathway.

BACKGROUND: The prevalence of obesity and overweight in childhood has increased dramatically over the past decades globally. Thus, the risk factors of overweight and obesity in children and adolescents must be studied. OBJECTIVES: This study aimed to reveal the prevalence of childhood obesity and examine the relationship between socioeconomic status (SES) and z-body mass index (z-BMI) via parental obesity and dietary intake using path analysis. METHODS: Stratified cluster sampling was used to select 17,007 participants aged 6-12 years on two avenues per region in urban, suburban, and rural areas. Path analysis was conducted to examine the mediators between SES and z-BMI. RESULTS: The prevalence rates of overweight and obesity were 13.36% and 8.60%, respectively, and were positively correlated with the father's education level, family income, a birth weight > 3000g, a parental obesity history, vegetable intake and red meat intake (all P < 0.05). Four mediators (paternal obesity history, red meat intake, vegetable intake, and nutritional supplements) were observed, and the four path analyses were significant (all P < 0.05). The adjusted total effects on z-BMI were significant for income (β CONCLUSIONS The prevalence of overweight/obesity in children was notable, and the relationship between SES and z-BMI was mediated by paternal obesity history and dietary intake.
Child ; China/epidemiology* ; Cross-Sectional Studies ; Eating/psychology* ; Fathers/statistics & numerical data* ; Female ; Humans ; Male ; Obesity/psychology* ; Pediatric Obesity/etiology* ; Social Class

Objective    To verify the reliability of Anticlot Assistant, a patient self-management system for warfarin therapy assisted by artificial intelligence. Methods    It was a single-center, prospective cohort study. The eligible 34 participants were recruited consecutively between November 29, 2017 to September 27, 2018 and managed by warfarin therapy via Anticlot Assistant. The recommendations of Anticlot Assistant were examined and verified by the doctors to ensure the security. Medical records were exported from the the background management system. An univariate analysis compared the outcomes between accepted and overridden records and a logistic regression model was built to determine independent predictors of the outcomes. The research team analyzed 153 medical records, which were from 18 participants and were input by 19 doctors. There were 97 records with doctor accepting the suggestion and 56 records with doctor rejecting the suggestion . Results    When the doctors accepted the recommendations, the percentage of the next-test international normalized ratio (INR) in the therapeutic range was higher (64.95% vs. 44.64%, RR=2.298, 95%CI 1.173 to 4.499, P=0.014). The logistic regression analysis revealed that accepting the recommendations was an independent predictor for the next-test INR being in the therapeutic range after controlling potentially confounding factors (OR=2.446, 95%CI 1.103 to 5.423, P=0.028). Conclusion    The algorithm of Anticlot Assistant is reasonable and reliable.

Objective:To evaluate an anticoagulation management method based on mobile health technology and artificial intelligence.Methods:The study was a single-center, prospective, randomized, controlled, non-inferiority clinical trial. From November 2017 to September 2018, 67 patients who received warfarin therapy after mechanical valve replacement were consecutively enrolled and randomized into two groups: 34 were randomized to intervention group and 33 to control group. The intervention group was managed via Anticlot Assistant and the control group was handled as routine care. Evaluations were performed at least 3 months after enrollment and ended on 30 September 2019. Non-inferiority was evaluated using one-sided tests with a non-inferiority margin set 11.0% for time in therapeutic range (TTR) and 10.0% for the percentage of international normalized ratio (INR) in the therapeutic range.Results:The mean TTR was (58.2±23.4)% in the intervention group and (54.8±23.6)% in the control (the difference: 3.4%; low limit of one-side 95% confidence interval for the difference: -6.4%; and P value for non-inferiority was 0.009). The percentage of INR in the therapeutic range was (55.4±21.9)% in the intervention group and (52.8±22.5)% in the control (the difference: 2.6%, low limit of one-side 95% confidence interval for the difference: -6.6%; and P value for non-inferiority was 0.012). Conclusion:The outcomes of patients managed via the anticoagulation management method base on mobile health technology and artificial intelligence are not inferior to those handled as routine care.

Background: and Purpose: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most-common form of autoimmune encephalitis, but its early diagnosis is challenging.This study aimed to identify the risk factors for a poor prognosis in anti-NMDAR encephalitis and construct a prognostic composite score for obtaining earlier predictions of a poor prognosis. Methods: We retrospectively analyzed the clinical data, laboratory indexes, imaging findings, and electroencephalogram (EEG) data of 60 patients with anti-NMDAR encephalitis. The modified Rankin Scale (mRS) scores of patients were collected when they were discharged from the hospital. The mRS scores were used to divide the patients into two groups, with mRS scores of 3–6 defined as a poor prognosis. Logistic regression analysis was used to analyze independent risk factors related to a poor prognosis. Results: This study found that 23 (38.3%) and 37 (61.7%) patients had good and poor prognoses, respectively. Logistic regression analysis showed that age, disturbance of consciousness at admission, and ≥50% slow waves on the EEG were significantly associated with patient outcomes. An age, consciousness, and slow waves (ACS) composite score was constructed to predict the prognosis of patients with anti-NMDAR encephalitis at an early stage based on regression coefficients. Conclusions Age, disturbance of consciousness at admission, and ≥50% slow waves on the EEG were independent risk factors for a poor prognosis. The ACS prognostic composite score could play a role in facilitating early predictions of the prognosis of anti-NMDAR encephalitis.

Objective: To analyze the main influencing factors of transitional care needs for children with chronic disease, so as to provide evidence for formulating the appropriate transitional care mode for children with chronic disease. Methods: Adopting complete random sampling and using self-designed questionnaire, investigate the need for 500 children with chronic disease who were hospitalized in the Children′s Hospital of Chongqing Medical University from May to October in 2017. Classification based on demand results. Using Chi square test, Fisher exact probability, Cochran-Armitage trend test, Bonferroni method and Logistic regression analysis the influencing factors of demand outcomes. Results: That affect the patient′s needs included family economy, medical insurance, children′s age, residence and Primary caregiver′s education, age, sex, relationship with children and so on. These factors had different effects on the need of transitional care. Conclusions The transitional care needs of children with chronic diseases are affected by many factors, which affect many aspects of continuous care. These influencing factors should be taken into account in continuous care service, and personalized continuous care services should be provided to meet children′ needs according to local conditions.

Objective To investigate the effect of prior statin use on outcome after intravenous thrombolysis in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke treated with intravenous thrombolysis at the Department of Neurology, the Third People's Hospital of Chengdu from July 2014 to August 2017 were enrolled, and divided into the statin use group and nonstatin use group according to prior statin use. Symptomatic intracranial hemorrhage and the outcome at 90 days after onset (good outcome and poor outcome were defined as the modified Rankin Scale score 0-2 and > 2, respectively) in the two groups were compared, and multivariate logistic regression analysis was used to identify the effect of prior statin use on the outcome. Results A total of 327 patients were enrolled, including 68 (20. 80％ ) in the statin use group, and 59 (79. 20％ ) in the nonstatin use group. There were no significant differences in the incidence symptomatic intracranial hemorrhage (7. 35％ vs. 10. 04％; χ2 = 0. 453, P = 0. 501), good outcome rate at 90 days (69. 12％ vs. 66. 02％; χ2 = 0. 232, P = 0. 630), and mortality rate (7. 35％ vs. 7. 34％; P = 1. 000) between the statin use group and the nonstatin use group. Multivariable logistic regression analysis showed that prior statin use were not an independent risk factor for symptomatic intracranial hemorrhage (odds ratio 0. 658, 95％ confidence interval 0. 233-1. 857; P = 0. 429) and poor outcome at 90 dafter onset (odds ratio 0. 848, 95％ confidence interval 0. 424-1. 696; P = 0. 641) in patients treated with intravenous thrombolysis. Conclusion Prior statin use is not associated with symptomatic intracranial hemorrhage and outcome after intravenous thrombolysis in patients with acute ischemic stroke.

Objective To investigate the clinical value of thrombelastogram (TEG) in prediction for the cause of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods In this study, there were 30 patients with DCI (group DCI) and 45 patients without DCI (group No-DCI). TEG was performed in all the patients at post-bleeding day 1, 5, 10 and 15 after aSAH(PBDn, n=1,5,10,15). The changes of reaction time (R value), coagulation time (K value),coagulation angle (α value),maximum thrombus consistency (MA value) and coagulation index (CI value) were examined at different time points after aSAH. Results Thirty of 75 aSAH patients developed DCI and the incidence of DCI was 40 percent. According to linear mixed model, both MA value and CI value were significantly statistical different at different time points within each group (P<0.05,for all) as well as between No-DCI group and DCI group.MA value and CI were significantly statistical different at same time point (P<0.05,for all). The results of logistic regression analysis showed that modified Fisher levelⅢ-Ⅳ,△MA5-1(OR=1.124,P=0.024,95% CI=1.015~1.244), PBD5 MA>70(OR=5.605,P=0.011,95% CI=1.464~21.457)were the independent risk factors of DCI.By using ROC curve to define a threshold for prediction of the occurrence of DCI,the rate of DCI was significantly increased when △MA5-1>3.05.Conclusion aSAH Patients, especially those with DCI have severe hypercoagulation. The MA value in PBD5 has an important predictive value for DCI.

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.

Objective To investigate the influences of atrial fibrillation (AF) on clinical outcome and hemorrhagic transformation (HT) after intravenous thrombolysis for acute ischemic stroke.Methods The patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled retrospectively.The modified Rankin Scale score 0-2 at 90 d was defined as a good outcome.Multivariate logistic regression analysis was used to determine the correlation between AF and clinical outcomes after intravenous thrombolvsis.Results A total of 160 patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator thrombolysis were enrolled,including 67 (41.88％) with AF.Compared with the non-AF group,the age was older (median [interquartile range] 77 [71-83] years vs.69 [59-78] years;Z=4.142,P＜ 0.001),baseline National Institutes of Health Stroke Scale (NHISS) score was higher (11.0[6.0-17.0] vs.7.0[4.0-14.0];Z=2.623,P=0.009)in the AF group.There were no significant differences in the NIHSS score reduction and the proportion of patients with good outcomes at 24 h (3.0 [1.0-4.5] vs.2.0 [0-6.0];Z=-0.312,P=0.775) and7d(4.0 [2.0-5.0] vs.5.0[2.0-8.0];Z=l.574,P=0.115) after thrombolysis and the proportion of patients with good outcome at 90 d (38.81％ vs.25.82％;x2 =3.063,P =0.080) between the AF group and the non-AF group,however,the proportions of HT within 24 h (14.93％ vs.5.38％;x2 =4.179,P =0.041) and death within 90 days (16.42％ vs.6.45％;x2 =4.073,P =0.044) in the AF group were significantly higher than those in the non-AF group.Multivariate logistic regression analysis showed that AF was not independent correlation with the clinical outcomes at 90 d (odds ratio [OR] 0.950,95％ confidence interval [CI]0.381-2.366;P =0.912),HT within 24 h (OR 1.992,95％ CI0.580-6.369;P =0.285),and death within 90 d (OR 2.483,95％ CI 0.727-8.586;P=0.146).Conclusion AF is not the independent risk factor that influences on clinical outcome at 90 d and-HT within 24 h after intravenous thrombolysis in patients with acute ischemic stroke.