Objective:To explore the social and physical anhedonia and its relationship to intrinsic motivation in patients with schizophrenia.Methods:One hundred and twenty-five stable schizophrenic patients from three psychiatric hospitals in Hefei, Wuhu and Beihai, and 101 healthy controls from same communities were recruited.All subjects completed Chinese version of revised social anhedonia scale(RSAS-C), Chinese version of revised physical anhedonia scale(RPAS-C) and intrinsic motivation inventory for schizophrenia research(IMI-SR), while positive and negative syndrome scale(PANSS) and Calgary depression scale for schizophrenia(CDSS) were used to assess the clinical symptoms of schizophrenic patients.All analyses were conducted by SPSS 26.0 software.The Mann-Whitney U test and covariance analysis were used for comparison between the groups, and Spearman correlation and multiple logistic regression analysis were used to explore the association between the anhedonia and intrinsic motivation in schizophrenics. Results:Compared with controls, the RSAS-C (10.00(6.00, 14.00) vs 11.00(8.00, 15.00), Z=-2.187, P<0.05) and RPAS-C (12.00(7.50, 20.00) vs 16.00(10.00, 23.00), Z=-3.026, P<0.01) scores in patients were higher, but the differerce between the groups disappeared after controlling age, sex and years of education.The IMI-SR perceived choice subscore (31.00(28.00, 39.00 vs 36.00(31.00, 42.00), Z=-3.172, P<0.01) were lower, while value/usefulness subscores (41.00(35.00, 45.00) vs 36.00(32.00, 42.00), Z=-3.387, P<0.01) were higher in patients than those in controls, and there was no significant difference between the total score and interest/enjoyment subscore(both P<0.05). In patents, Spearman correlation analysis showed that the RSAS-C and RPAS-C scores were significant negatively correlated with the IMI-SR total scores and interest/enjoyment subscore, perceived choice and value/usefulness( r=-0.193--0.364, all P<0.05), which still existed after controlling age, sex, years of education, course of disease, antipsychotic dose, and scores of PANSS and CDSS.Logistic regression analysis showed that the score of RSAS-C( B=-0.096, 95% CI=0.836-0.998, P=0.025) and perceived choice subscore( B=-0.110, 95% CI=0.823-0.974, P=0.010) had negative effects on the IMI-SR total score. Conclusion:There is a correlation between anhedonia and intrinsic motivation in patients with schizophrenia, the higher the social anhedonia, the lower the intrinsic motivation to participate in cognitive activities, suggesting that intervention for social anhedonia may have significance in improving the intrinsic motivation of patients with cognitive rehabilitation therapy.

Background: Neurolytic celiac plexus block (NCPB) is a typical treatment for severe epigastric cancer pain, but the therapeutic effect is often affected by the variation of local anatomical structures induced by the tumor. Greater and lesser splanchnic nerve neurolysis (SNN) had similar effects to the NCPB, and was recently performed with a paravertebral approach under the image guidance, or with the transdiscal approach under the guidance of computed tomography. This study observed the feasibility and safety of SNN via a transdiscal approach under fluoroscopic guidance. Methods: The follow-up records of 34 patients with epigastric cancer pain who underwent the splanchnic nerve block via the T11-12 transdiscal approach under fluoroscopic guidance were investigated retrospectively. The numerical rating scale (NRS), the patient satisfaction scale (PSS) and quality of life (QOL) of the patient, the dose of morphine consumed, and the occurrence and severity of adverse events were recorded preoperatively and 1 day, 1 week, 1 month, and 2 months after surgery. Results: Compared with the preoperative scores, the NRS scores and daily morphine consumption decreased and the QOL and PSS scores increased at each postoperative time point (P < 0.001). No patients experienced serious complications. Conclusions SNN via the transdiscal approach under flouroscopic guidance was an effective, safe, and easy operation for epigastric cancer pain, with fewer complications.

Objective:To evaluate the efficacy of proximal humerus internal locking system (PHILOS) via the minimally invasive plate osteosynthesis (MIPO) in the treatment of proximal humeral fractures.Methods:This retrospective study analyzed 30 elderly patients with proximal humeral fracture who had been treated by PHILOS via MIPO from September 2016 to March 2020 at Department of Orthopedic Surgery, People’s Hospital of Zhuxi County. They were 19 females and 11 males with an average age of 60.96 years (from 45 to 80 years). All patients were treated by closed reduction. After fracture reduction was confirmed by fluoroscopy, a minimally invasive incision was made below the acromion, with a couple of suture wires reserved at the rotator cuff attachments. A PHILOS plate was inserted at 4 mm lateral to the intertubercular sulcus, with the suture wires passing through the proximal suture holes on the PHILOS. After a lag screw was first screwed up into the compression hole on the PHILOS plate, the crossing suture wires were tightened up to resist the rotator cuff stress and maintain the internal inclination of the humeral head. Kirschner wires were used to temporarily stabilize the reduction. After satisfactory reduction and fine plate positions were confirmed by fluoroscopy, locking nails were screwed up. The internal inclination of the affected humeral head was compared between preoperation and the last follow-up. The therapeutic efficacy was evaluated by the shoulder Neer scoring system, and the visual analogue scale (VAS) pain scores and complications were recorded at the last follow-up.Results:All the 30 patients were followed for 6 to 18 months (average, 12 months). There was no incision infection, neurovascular injury, or internal fixation failure. Anatomical reduction was achieved in 25 patients and functional reduction in 5. The inclination of the humeral head was significantly improved. The VAS scores at the last follow-up averaged 1.9. Follow-up X-ray examination showed that bony union was achieved after 6 to 18 months (average, 9 months) for all patients. At the last follow-up, the inclination angle of the affected humeral head was 130°±5°, significantly improved compared with the preoperative 90°±11.2° ( P<0.05). All patients had good functional recovery of the shoulder. The efficacy was, according to the Neer shoulder scores at the last follow-up, excellent in 22, good in 6 and fair in 2 cases. Conclusions:Treatment of proximal humeral fractures using PHILOS via MIPO technique is suitable for patients with osteoporotic fracture, and may lead to fine therapeutic efficacy.

Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) complicated with "top of the basilar" syndrome (TOBS) in children. Method The clinical data of MPP complicated with TOBS in a child were retrospectively analyzed, and the related literature was reviewed. Results A 6-year-old girl developed fever and inflexible movement in unilateral limb, and serum Mycoplasma pneumoniae antibody increased gradually. Lung CT showed a large area of inflammatory consolidation. Brain magnetic resonance imaging (MRI) showed multiple cerebral infarctions. After the symptomatic treatment of anti-infection, anticoagulation, thrombolysis and intracranial pressure reduction, the girl's condition continued to worsen and she presented with coma, cough weakness, dysphagia, facial nerve paralysis and bilateral pupillary inequality. Although the vital signs of the child were stable, she could not take care of herself and was still recovering. Conclusion MPP is often accompanied by hypercoagulative state and autoimmune abnormalities, and the prognosis of patients combined with TOBS is poor.

Objective Using small interfering RNA (siRNA) against p38 and simulated lung transplantation model,we discussed the effect of p38 siRNA on hypoxia/reoxygenation injury of pulmonary microvascular endothelial cells (PMVECs) after lung transplantation.Methods We transfected the PMVECs with p38 siRNA or non-targeting (NT) siRNA.After 48 h,these cells were exposed to simulated ischemia-reperfusion.At 2 h and 4 h of reperfusion,we detected lactate dehydrofenase (LDH) leakage rate,malondialdehyde (MDA) levels,superoxide dismutase (SOD) activity,cell apoptosis,and the serum levels of interleukin (IL)-1,IL-6 and tumor necrosis factor (TNF)-α.Protein levels of p38,NF-κB and AP-1 were detected.Untreated PMVECs served as the negative control.Results As compared with NT siRNA,p38 siRNA reduced LDH leakage rate (22.3 ± 5.7 vs.45.1 ± 6.2 and 46.3 ± 7.3 vs.75.6 ± 12.4),decreased MDA levels (4.1 ± 2.2 vs.7.1 ± 2.1 and 3.9 ± 0.5 vs.6.1 ± 1.2),increased SOD activity (12.8 ± 3.2 vs.9.4 ± 1.1 and 10.8 ± 1.2 vs.7.0 ± 1.1),and inhibited apoptosis (2.8 ± 0.6 vs.4.1 ± 1.4 and 3.1 ± 1.1 vs.5.8 ± 1.3).p38 siRNA reduced the levels of IL-1 (288 ± 89 vs.592 ± 95 and 380 ± 94 vs.775 ± 175) and IL-6 (38 ± 5 vs.70 ± 12 and 80 ± 20 vs.118-± 17),however,had no influence on TNF-α level.Silencing p38 gene decreased phosphorylation of p65 and inhibitor of nuclear factor kappa-B kinase β,and increased inhibitor of nuclear factor kappa-B expression.However,p38 siRNA had no effect on the phosphorylation of c-Jun and c-Fos.Conclusion Through inhibiting the NF-κB classic activation pathway,p38 siRNA reduced oxidative stress,inflammation and apoptosis of rat PMVECs,protected membrane integrity,and reduced hypoxia/reoxygenation injury.

Objective To investigate the effect of intratracheal injection of c-Jun N-terminal kinase ( JNK) siRNA plasmid on ischemia-reperfusion ( I∕R) injury in a rat model of lung transplantation. Meth-ods ExperimentⅠ Thirty-two male Wistar rats, weighing 250-280 g, were divided into 2 groups ( n=16 each) using a random number table method: control group ( group C) and JNK siRNA group. JNK siR-NA plasmid 2 mg∕kg ( diluted to 0. 2 ml in sterile phosphate buffer solution) was intratracheally injected in JNK siRNA group. Scrambled siRNA plasmid 2 mg∕kg ( diluted to 0. 2 ml in sterile phosphate buffer solu-tion) was intratracheally injected in group C. Six rats in each group were sacrificed at 48 h of administra-tion, and left lung tissues were removed for determination of the expression of JNK and JNK mRNA ( by Western blot and real-time polymerase chain reaction, respectively) . The other 10 rats left in each group were used for left lung transplantation. Experiment Ⅱ Thirty male Wistar rats, weighing 250-280 g, were divided into 3 groups ( n=10 each ) using a random number table method: sham operation group ( group S) , transplanted lung I∕R group ( group I∕R) and transplanted lung I∕R+JNK siRNA group ( group I∕R+JNK siRNA) . In group I∕R and group I∕R+JNK siRNA, the left lung transplantation was performed, and the donor lungs were obtained from the living donors in group C and group JNK siRNA, respectively. At 15 min of mechanical ventilation and 30, 60, 90 and 120 min of reperfusion, arterial blood samples were obtained for blood gas analysis, PaO2 was recorded, and the oxygenation index ( PaO2 ÷ FiO2 ) was calculated. Arterial blood samples were obtained at 120 min of reperfusion in transplanted lungs for determi-nation of concentrations of interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α) and interferon-γ( IFN-γ) in serum ( using enzyme-linked immunosorbent assay) , and the rats were sacrificed and left lung tissues were removed for microscopic examination of the pathological changes which were scored and for de-termination of wet∕dry lung weight ratio ( W∕D ratio) , and nuclear factor kappa B ( NF-κB) and activator protein-1 ( AP-1) activities ( using enzyme-linked immunosorbent assay) . Results ExperimentⅠ Com-pared with group C, the expression of JNK and JNK mRNA was significantly down-regulated in group JNK siRNA (P<0. 05). ExperimentⅡ Compared with group S, the oxygenation index was significantly de-creased, and the concentrations of serum IL-8, TNF-α and IFN-γ, W∕D ratio, lung injury score and ac-tivities of NF-κB and AP-1 were increased in I∕R and I∕R+JNK siRNA groups ( P<0. 05) . Compared with group I∕R, the oxygenation index of receptors were significantly increased, and the concentrations of serum IL-8, TNF-α and IFN-γ, W∕D ratio, lung injury score and activities of NF-κB and AP-1 were decreased in group I∕R+JNK siRNA ( P<0. 05) . Conclusion Intratracheal injection of JNK siRNA can reduce trans-planted lung I∕R injury, and the mechanism may be related to inhibiting inflammatory responses of rats.

Objective To evaluate the clinical efficacy of percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing for pediatric radial neck fractures of O'Brien types Ⅱ & Ⅲ.Methods From January 2014 to June 2016,38 children (23 boys and 15 girls) with radial neck fracture of O'Brien type u or Ⅲ were treated by percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing in our department.We had 26 left and 12 right sides.Their ages ranged from 5 to 14 years,averaging 8.6 years.All fractures were fresh.According to O'Brien classification,22 cases were type Ⅱ and 16 type Ⅲ.The operation time,frequency of intraoperative C-arm fluoroscopy,frequency of percutaneous haemostat stroke-poking reduction,and union time were recorded.The elbow function was assessed one day before removal of internal implants according to the Métaizeau scoring system.Results All operations succeeded,lasting from 12 to 25 min (average,16.4 min).The frequency of intraoperative fluoroscopy ranged from 3 to 11 times (average,6.4 times);the frequency of intraoperative percutaneous reduction ranged from 1 to 4 times (average,2.3 times).The patients were followed up for 6 to 22 months (average,1 1.2 months).Postoperative X-ray films showed satisfactory alignment of the fracture ends.All fractures demonstrated clinical and radiographic evidence of complete healing after a mean time of 58 days (from 38 to 72 days).The Métaizeau scoring showed 33 excellent,4 good and one fair cases,yielding an excellent to good rate of 97.4％.Follow-ups revealed no infection,implants breakage,nonunion,fracture redisplacement,or iatrogenic radial nerve injury.Conclusions As percutaneous haemostat stroke-poking reduction can increase the probability of successful reduction at first attempt,reduce frequency of close reduction and X-ray exposure for both children and medical staff,and shorten operation time,the procedure is effective,simple,reliable and minimally invasive,leading to fewer complications.

Objective To evaluate the clinical curative effect of Salvia miltiorrhiza Ligustrazine combined with Butylphthalide in cerebral infarction of children. Methods Sixty-two children with acute cerebral infarction were randomly divided into treatment group (33 patients) and control group (29 patients). The patients in two groups received the same basic treatment. The control group used Salvia Ligustrazine injection, and the treatment group used Salvia Ligustrazine injection combined with Butylphthalide. The total efficiency, the degree of recovery of muscle strength and the scores of nerve defect 2 weeks after treatment were compared. Results The total efficiency in treatment group was 87.9%(29/33), in control group was 75.9%(22/29), and there was significant difference (P<0.05). Two weeks after treatment, the muscle strength scores in treatment group was (4.00 ± 0.47) scores , in control group was (3.59 ± 0.98) scores, and there was significant difference (P<0.05). Two weeks after treatment, the scores of nerve defect in treatment group was (5.42 ± 2.18) scores, in control group was (6.86 ± 2.23) scores, and there was significant difference (P<0.05). Conclusions Salvia Ligustrazine combined with Butylphthalide in treatment of cerebral infarction of children has obvious effect, and it is worthy of spreading.

Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children.Methods From January 2011 to December 2015,54 older children(31 males and 23 females) aged 8-14 years(average 11.4 years old) of humeral shaft fractures were treated in Children's Hospital of Nanjing Medical University with elastic stable intramedullary nail.The left side involved 24 cases and right involved 30 cases.Patients were divided into 3 groups according to different approaches:bilateral retrograde group (31 cases),radial retrograde group (15 cases) and anterograde group (8 cases).Abduction brace was carried out postoperatively for about 6 weeks.Implant removal took place about 3-4 months later,when the X-ray showed fracture line disappeared and continuous trabecular bone was formed.A retrospective study was performed to compare the operation time,imaging findings after the surgery,fracture healing time and recent complications among the 3 groups.Results Bilateral retrograde nailing operation lasted for an average of (51 ±25) min and residual angle in X-ray films postoperative was (5.4 ± 1.8) °.The radial retrograde nailing average operating time was(46 ± 12)min and average residual angle in X-ray films postoperative was (12.8 ±2.9)°,while anterograde nailing was (44 ±16) min and (13.0 ± 3.6)°.The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group,and the difference was statistically significant (F =19.340,P ＜ 0.01).Children were followed up for 6 to 18 months (averaged 11 months).Each fracture was healed successfully.The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8％ (30/31 cases),93.3％ (14/15 cases),87.5％ (7/8 cases).The excellent rates of Mayo scores of elbow joints 6 months after surgery were 93.5％ (29/31 cases),100.0％ (15/15 cases),100.0％ (8/8 cases).All fractures were healed without abnormal appearance or decreased range of motion.In terms of their complications,in the bilateral retrograde group,there was 1 case of iatrogenic ulnar nerve palsy and 5 cases with skin irritation.One case of skin irritation occurred in the radial retrograde group.Conclusions In treatment of humeral shaft fractures in older children,functional outcomes are similar in 3 groups.The technique of bilateral retrograde insertion is effective and has extensive applicability.