Objective To investigate the effects of climate change on the geographical distribution of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Gansu Province,and predict its potential habitat;To provide a theoretical basis for resource conservation of cultivation of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao.Methods Based on the distribution data of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao from field surveys,the maximum entropy model and geographic information system were used to simulate its potential habitat in Gansu Province for the current(1970-2000)and future(2041-2060)periods,and the contribution of environmental factors and the results of the knife-cut test were integrated to assess the important factors governing the distribution of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao.Results The dominant environmental variables governing the geographical distribution of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao were precipitation in the wettest month,average temperature in the wettest season,and elevation.The potential suitable area of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Gansu Province under current climatic conditions was 65 902.66 km2,and the high suitable area was mainly concentrated in Dingxi District.In the future period,the suitable areas of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao under the scenarios of SSP126,SSP370 and SSP585 all showed a decreasing trend,especially the area of the high suitable areas decreased significantly.Conclusion Future climate change will lead to a significant reduction in the suitable habitat for A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Gansu Province.The suitable habitat will mainly move towards high-altitude mountainous areas,and the continuity of A.membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao resources can be maintained by establishing ecological protection zones.

Objective:To explore the application value of free nail flaps in reconstruction of nail bed and fingertip defect.Methods:From January 2018 to June 2020, nine patients with free nail flap transplantation to treat fingertip injuries in Lishui People′s Hospital were included in this study. According to the Allen classification, 6 patients were characterized as type Ⅱ and 3 were characterized as type Ⅲ. Evaluation was based on the patients′ medical records and follow-up, including postoperative healing of recipient and donor sites, two-point discrimination, the Chinese Medical Association Hand Surgery Society′s evaluation of the function of severed finger replantation, and Michigan Hand Outcomes Questionnaire (MHQ) and Foot Function Index (FFI).Results:All patients successfully completed the operation, the operation time was 3.0-5.0 h (average 4.1 h), the intraoperative blood loss was 100-250 ml (average 178 ml), and the follow-up time was 12-40 months (average 25 months). The nails and flaps of all patients survived with primary healing. No complications were observed after surgery. The appearance of the reconstructed finger of 9 patients was similar to that of the uninfected side; the flap two-point discrimination was 5.0-7.5 mm; the replantation score and MHQ results were satisfactory. The toenail of the donor site grew well, and no deformity or pain with walking was noted.Conclusions:The free toenail flap was used to treat fingertip defects, with satisfactory clinical results in repairing tissue defects, reconstructing nail bed and maintaining finger length.

Objective:To investigate the effects of aerobic combined stretching exercise during dialysis on the severity of restless legs syndrome(RLS), quality of life and sleep quality in hemodialysis (HD) patients.Methods:A total of 63 HD patients with RLS who were admitted to the Hemodialysis Center, Renmin Hospital of Wuhan University from March 2018 to March 2019 were selected as research objects. According to the random number table method, they were divided into the observation group (32 cases) and the control group (31 cases). Patients in the control group were given conventional nursing methods while patients in the observation group were given the aerobic combined stretching exercise during dialysis. The International Restless Legs Syndrome Rating Scale (IRLS) Kidney Disease Quality of Life, (KDQOL-36 TM), Pittsburgh Sleep Quality Index(PSQI) and blood chemistry were used to evaluate the effect of exercise on HD patients with RLS. Results:After intervention, the observation group ′s IRLS scores was 12.19±4.48, lower than the control group (17.87±3.91), the difference was statistically significant ( t value was 3.021, P<0.05). The scores of physical health, mental health, kidney burden, symptoms and discomfort, effects of kidney disease in KDQOL-36 TM of the observation group were 44.56±6.64, 46.12±4.95, 19.92±15.91, 87.59±5.65, 64.55±13.20, higher than the control group (37.43±4.81, 41.81±4.87,12.10±14.87, 78.83±7.96, 55.45±15.52), the differences were statistically significant ( t values were -5.027--2.015, P<0.05). The PSQI total score was 8.94±2.54, lower than that of the control group (13.13±1.31), the difference was statistically significant ( t value was 8.271, P<0.05). The blood phosphorus was (1.80±0.48) mmol/L in the observation group, lower than (2.04±0.34) mmol/L in the control group, and hemoglobin, blood calcium [(105.31±13.58) g/L, (2.26±0.20) mg/L] were higher than those in the control group[(99.52±8.21) g/L, (2.05±0.29) mg/L], the differences were statistically significant ( t values were 2.275, -2.042, -3.325, P<0.05). Conclusions:The aerobic combined stretching exercise during dialysis relieves the symptom of RLS, improves the sleeping quality and quality of life.

Breast cancer has become one of the major factors that threaten women's health. The spouse, as an intimate partner and its main caregiver, has many unmet needs during the care period, which indirectly reflects the quality of life and needs of the patient. This article reviews the measurement tools, content of needs and influencing factors of spouse needs of breast cancer patients, and so as to provide a basis for further exploring spouse needs in China and formulating personalized intervention plans for spouses of patients with different needs at different stages.

Objective To explore the expression and clinical pathological significance of long non-coding transcription factor 7 (lncTCF7) in gastric cancer tissues and to investigate the role of lncTCF7 in the invasion and metastasis of gastric cancer by in vitro experimental study.Methods From January to June 2011,one hundred patients with gastric cancer who underwent radical gastrectomy were selected from Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.The expression of lncTCF7 at mRNA level was detected by quantitative real-time polymerase chain reaction (qRT-PCR).The patients were divided into high expression group (50 cases) and low expression group (50 cases) according to the lncTCF7 mRNA expression level.The stable interferenced lncTCF7 cell line (stable interference group) and blank control lncTCF7 cell line (blank control group) were established.Then the relationship between lncTCF7 expression level and clinical pathological characteristics and prognosis was analyzed.The interferenced lncTCF7 cell line was constructed and utilized,and the role of lncTCF7 in the invasion and metastasis of gastric cancer was detected by wound healing,Transwell and Western blotting method.The Chi square test and t test were performed for statistical analysis.The Kaplan-Meier curve was used for survival analysis.Univariate and multivariate analyses were used for screening the independent factors affecting prognosis.Results The results of qRT-PCR showed that the expression levels of lncTCF7 mRNA in high expression group and low expression group were 0.019 ± 0.003 and 0.002 ± 0.001,respectively.The survival rate of high expression group was lower than that of low expression group (46％,23/50 vs.72％,36/50),and the difference was statistically significant (P =0.002 5).The expression level of lncTCF7 was correlated with intravascular tumor thrombus formation,nerve invasion,depth of invasion and lymph node metastasis (x2 =7.862,7.162,11.903 and 8.280,all P ＜ 0.05).The results of univariate and multivariate analyses showed that the expression level of lncTCF7 was significantly correlated with the depth of invasion (hazard ratio (HR) =4.205,P =0.002;HR =3.125,P =0.018).The results of wound healing assay indicated that lncTCF7 interference could significantly inhibit wound healing ((92.90 ± 1.51) ％ vs.(12.33 ± 0.67) ％,t =48.72,P ＜ 0.01).The results of Transwell assay demonstrated that after 24 hours of culture the number of cells passed through the membrane of the chamber of blank control group was higher than that of stable interference group (83.6 ± 12.5 vs.26.6 ± 4.3),and the difference was statistically significant (t =9.65,P ＜ 0.01).The results of Western blotting showed that the expression of E-cadherin,a marker of epithelial origin,of stable interference group was significantly increased compared with that of blank control group (0.32 ±0.01 vs.0.76 ± 0.01),however the expression levels of vimentin and N-cadherin,markers of mesenchymal origin,were significantly decreased (0.56 ±0.01 vs.0.39 ± 0.01 and 0.67 ± 0.01 vs.0.33 + 0.01),and the differences were all statistically significant (t =26.68,10.09 and 24.14,all P ＜ 0.05).Conclusions The prognosis of gastric cancer patients with high expression of lncTCF7 is poor.lncTCF7 may promote the invasion and metastasis of gastric cancer by influencing eoithelial-mesenchymal transition in gastric cancer cells.

Objective To explore the effects of aripiprazole on clinical symptoms and neurotrophic factor levels in patients with schizophrenia. Methods Forty patients with schizophrenia and 40 normal controls were included in the study. The clinical symptoms of patients receiving aripiprazole only for 12 weeks were evaluated by using the Positive and Negative Syndrome Scale (PANSS). Stroop Color-Word Test (SCWT), Continuous Performance Test, Digit-Symbol Coding Test and Trail Making Test-A were used to evaluate the cognitive function both in patients and controls. Serum levels of Nerve Growth Factor (NGF), Brain Derived Neurotrophic Factor (BDNF) and Neurotrophin 3 (NT-3) were measured using enzyme linked immunosorbent assay. Results The clinical scores, cognitive function and levels of neurotrophic factors were different before and after treatment (P<0.01). And those were significantly lower in patients than in control group (P<0.05). Before treatment, BDNF was negatively correlated with PANSS negative symptom score (r=-0.362, P=0.022);NGF was related to the total score of PANSS (r=0.332, P=0.037) and positive symptoms (r=0.401, P=0.010); NT-3 was associated with negative symptom scores (r=-0.376, P=0.017) and SCWT-color words (r=0.332, P=0.037) in patient group. After treatment, the increase in BDNF was correlated with the reduction in PANSS total score (r=0.371, P=0.018), negative symptom score (r=0.345, P=0.029) and general pathology score (r=0.342, P=0.031). There was a correlation of the increase of NGF with the decrease of PANSS total scores (r=0.437, P=0.005) and with positive symptom scores (r=0.357, P=0.024). Conclusion Treatment with Aripiprazole can improve the clinical symptoms and cognitive functiona impairments in patients with schizophrenia, which may be related to the increase in serum levels of BDNF, NGF and NT-3.

Objective To develop the female breast cancer patients' needs assessment scale and test its reliability and validity.Methods Based on extensive literature and Maslow model, the initial assessment scale of female breast cancer patients' needs was established by literature analysis, qualitative interviews and experts consultation. The method of convenience sampling was used to conduct the pilot survey, and evaluate its reliability and validity.Results The initial needs assessment scale of breast cancer patients consists of 37 items. Through item discrimination, correlation analysis, Cronbach's α, factor analysis, 7 items were deleted, and the 30 items scale was eventually formed and consists of 5 dimensions, including physiological needs, safety needs, love and belonging needs, esteem needs and self-actualization needs. The overall Cronbach's α and split half reliability were 0.952 and 0.856 respectively. The content validity ratio (CVI) was 0.99. Construct validity was analyzed by the method of factor analysis. The 5 common factors extracted by orthogonal rotation with principal component method showed consistency with the theoretical conception. The results showed good reliability and validity of the scale.Conclusions Based on Maslow's hierarchy of needs theory, the female breast cancer patients' needs assessment scale has good reliability and validity, and can be used to evaluate the needs of breast cancer patients.

Background: Mast cell activation is a characteristic of irritable bowel syndrome (IBS).Study on mast cell and the related inflammatory mediators in colonic mucosa is helpful for the evaluation and treatment of IBS.Aims: To assess the effect of mesalazine combined with trimebutine on colonic mucosal mast cell and related inflammatory mediators in patients with IBS.Methods: Forty patients with diarrhea-predominant IBS (IBS-D) and 40 patients with constipation-predominant IBS (IBS-C) from Oct.2014 to June 2016 at Shanghai Jiading District Central Hospital were enrolled, 20 healthy volunteers were served as controls.Forty patients with IBS-D and 40 patients with IBS-C were randomly divided into mesalazine+trimebutine group and trimebutine group, the treatment courses were all 4 weeks.Number of mast cell was counted by modified toluidine blue staining.Score of related inflammatory mediators were evaluated by immunohistochemistry.Clinical efficacy was assessed.Results: Compared with healthy controls, number of mast cell at baseline was significantly increased both in IBS-D and IBS-C patients (P<0.05).After treatment with mesalazine+trimebutine, number of mast cell was significantly decreased (P<0.05).At baseline, immunohistochemical staining score of 5-HT, IL-1, TNF-α, histamine, tryptase were significantly increased in IBS patients than in healthy controls (P<0.000 1).After treatment with mesalazine+trimebutine, above-mentioned inflammatory mediators were significantly decreased (P<0.05).In IBS-D patients, the total efficacy rate in mesalazine+trimebutine group was significantly increased than that in trimebutine group (85.0% vs.45.0%, P=0.008).In IBS-C patients, no significant difference in total efficacy rate was found between mesalazine+trimebutine group and trimebutine group (55.0% vs.25.0%, P=0.053).Conclusions: Mesalazine combined with trimebutine is an effective and safe approach to reduce mast cell infiltration and release of related inflammatory mediators, and is more efficient for patients with IBS-D.

Objective To discuss the effect of Dickkopf-1 (DKK-1) on Wnt singal pathway during the differentiation of osteoblast in vitro.Methods The osteoblasts were obtained from the new rats and cultured in vitro.The 3 passages were divided into control group and DKK-1 group.The cells were cultured in DKK-1 and normal saline for morphogical detection,ALP activity detection and osteoblasts stained at 1 st,6th,12th,21st day.The Wnt was detected by RT-PCR.Results After cultured by the DKK-1 in vitro,the ALP and mineralization of osterblasts staining were prlonged with culture time.Compared with control group,the expression of Wnt was significantly reduced at the 21st day after induction (t =0.278,P ＜ 0.05).Conclusion DKK-1 can regulate the expression of Wnt during osteoblast differentiation,suggests that Wnt may be involved in osteoblast differentiation and can affect bone remodeling process.