AIM: To investigate the effects of Conbercept on various optical coherence tomography(OCT)biomarkers in patients with retinal vein occlusion-related macular edema(RVO-ME), and to analyze the correlation of these biomarker changes with visual prognosis.METHODS: Retrospective study. A total of 57 patients(57 eyes)with RVO-ME, including 25 patients(25 eyes)with central retinal vein occlusion(CRVO)and 32 patients(32 eyes)with branch retinal vein occlusion(BRVO), were enrolled in this study. All the patients received intravitreal injection of conbercept once a month, three times in total. The preoperative and postoperative best-corrected visual acuity(BCVA), and changes in OCT biomarkers, including central macular thickness(CMT), the length of disorganization of the retinal inner layers(DRIL), the number of hyperreflective dots(HRD), the area of intraretinal fluid(IRF), the area of subretinal fluid(SRF), and the length of ellipsoid zone(EZ)disruption were compared. Furthermore, the relationship of these changes with BCVA was analyzed.RESULTS:Compared with the baseline, at 3 mo post-treatment, BCVA(LogMAR)was improved, CMT was decreased, the length of DRIL was shortened, the number of HRD was reduced, the area of IRF was decreased, the area of SRF was reduced, and the length of EZ disruption was shortened(all P<0.05). Spearman correlation analysis showed that there was no correlation between the changes in CMT, the length of DRIL, the number of HRD, the area of IRF, the area of SRF and the change in BCVA before and after treatment(P>0.05). However, the change in the length of EZ disruption was positively correlated with the change in BCVA(rs=0.34, P=0.011), and the R2 value of the fitting curve between the change in the length of EZ disruption and the change in BCVA was 0.113(P=0.011). When comparing the pre- and post-treatment changes in BCVA, the length of DRIL, the number of HRD, the area of IRF, the area of SRF, and the length of EZ disruption between patients in the CRVO group and BRVO group, no significant differences were observed(all P>0.05). In contrast, a significant difference was found in the change in CMT between the two groups(P=0.002).CONCLUSION:Conbercept effectively improves multiple OCT biomarkers in patients with RVO-ME. Repair of EZ disruption is a key driver of visual recovery, and its stability may serve as a novel indicator for personalized decision-making in anti-vascular endothelial growth factor therapy.

Objective:To explore the effect of the specialized nursing team model in children with severe asthma.Methods:A total of 80 children with severe asthma admitted to the Respiratory Intensive Care Unit, Tangshan Maternal and Child Health Hospital of Hebei Province from October 2018 to October 2019 were selected and divided into control group and observation group according to the random number table, with 40 cases in each group. Children in control group were given routine nursing care, and children in intervention group were treated with the specialized nursing team model, and they were all treated until discharge. We compared the efficacy, disease perception with the Brief Illness Perception Questionnaire (BIPQ) , medical phobia with the Children's Medical phobia Questionnaire, and quality of life one month after discharge with the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) .Results:On the day of discharge, the total effective rate of clinical treatment of children in observation group was significantly higher than that of control group; and the scores of BIPQ and Children's Medical phobia Questionnaire of observation group were lower than those of control group, the differences were statistically significant ( P<0.05) . One month after discharge, the scores of symptom dimension and the total score of the PAQLQ of observation group were higher than those of control group, and the differences were statistically significant ( P<0.05) . Conclusions:The specialized nursing team model has a significant effect in the nursing care of severe asthma, which is conducive to improving the clinical efficacy of children, reducing children's disease perception and medical phobia, and improving children's quality of life.

Objective To explore the effects of self-management intervention under the self-efficacy theory on 7-14 years old children with asthma. Methods In this prospective study, totally 201 pediatric patients with asthma treated in Tangshan Maternal & Child Health Care Hospital from April 2016 to April 2018 were selected and divided into managed (n=42) and control (n=42) groups according to the random number table. Patients in the control group received conventional care according to the recommendations under Global Initiative for Asthma (GINA), while patients in the managed group received self-management intervention under the self-efficacy theory on this basis for 6 months. The frequency of asthma and emergency treatment during the intervention period was calculated, and the control of asthma and pulmonary function within 1 year after intervention was evaluated. Exercise of Self-care Agency Scale (ESCA) and Chronic Disease Resilience Scale for Children (CDRSC) were used to assess the self-care agency and psychological resilience of the two groups before and after intervention. Results Compared with the control group, the average frequency of asthma and emergency treatment was reduced in the managed group during the intervention period. The proportion of patients whose asthma was partially or fully controlled within 1 year after intervention increased, and there was statistically significant difference between the two groups (P＜ 0.05). Daytime and nighttime symptom scores and pulmonary function were ameliorated in both groups after intervention. The improvement effects were better in the managed group than in the control group, and there was statistically significant difference between the two groups (P＜0.05). The scores of self-concept, self-care responsibility, self-care skill and health knowledge in ESCA and the scores of personalities, coping style and interpersonal relationship in CDRSC increased in both groups after intervention. The scores of the managed group were higher than those of the control group, and there was statistically significant difference between the two groups (P＜0.05). Conclusions Self-management intervention under the self-efficacy theory can effectively improve the self-care agency and psychological resilience in 7-14 years old children with asthma, thus reducing the incidence of asthma and emergency treatment and improving the recovery of pulmonary function.

Objective To evaluate the relationship between the mechanism underlying inhibition of inflammatory responses induced by α7 nicotinic acetylcholine receptor(α7nAChR)agonist postcondition?ing alone or in combination with remote limb ischemic postconditioning during myocardial ischemia?reperfu?sion(I∕R)and glycogen synthase kinase?3β(GSK?3β)in rats. Methods Eighty adult male Sprague?Dawley rats, aged 8 weeks, weighing 290-320 g, were divided into 4 groups(n=20 each)using a ran?dom number table: I∕R group, α7nAChR agonist postconditioning group(group P), remote limb ische?mic postconditioning group(group L)and α7nAChR agonist postconditioning plus remote limb ischemic postconditioning group(group P+L). Myocardial I∕R was induced by 30 min occlusion of the left anterior descending branch of coronary artery followed by 120 min reperfusion. Specific α7nAChR agonist PNU282987 2 mg∕kg was intravenously injected immediately before reperfusion in group P. In group L, limb ischemia was induced by tourniquet occlusion of bilateral hind paws for 10 min starting from 20 min of myocardial ischemia, and the tourniquet was released at the beginning of reperfusion. Combination of inter?vention measures previously described in P and L groups was performed in group P+L. Venous blood sam?ples were taken at 120 min of reperfusion for determination of serum troponin I(TnI)and creatine kinase?MB(CK?MB)concentrations, myocardial infarct size(IS)and expression of phosphorylated GSK?3β [p?GSK?3β(Ser536)], NF?κBp65 and phosphorylated nuclear factor?κBp65(p?NF?κBp65)in myocar?dial tissues(by Western blot). Results Compared with group I∕R, myocardial IS and serum cTnI and CK?MB concentrations were significantly decreased, the expression of p?GSK?3β(Ser9)in ischemic area was up?regulated, and the expression of p?NF?κBp65 in ischemic area was down?regulated in P, L and P+L groups(P<0.05). Compared with group L, myocardial IS and serum cTnI and CK?MB concentrations were significantly decreased, the expression of p?GSK?3β(Ser9)in ischemic area was up?regulated, and the expression of p?NF?κBp65 in ischemic area was down?regulated in group P+L(P<0.05). Conclusion The mechanism by which α7nAChR agonist postconditioning alone or in combination with remote limb is?chemic postconditioning inhibits inflammatory responses during myocardial I∕R may be related to inhibiting GSK?3β activity in rats.

Objective To investigate the anti-inflammatory effect of penehyclidine hydrochloride on oleic acid-induced acute respiratory distress syndrome (ARDS) in rats.Methods According to randomize number table method, 30 adult male Sprague-Dawley (SD) rats were divided into control group, model group and treatment group. Catheters were placed in femoral vein in each group. The control group was injected with 1.1 mL/kg physiological saline; the model group was injected with 0.1 mL/kg oleic acid and then injected with 1.0 mL/kg normal saline to establish ARDS model; the treatment group was injected with 0.1 mL/kg oleic acid and then injected with 1.0 mL/kg penehyclidine hydrochloride. At 3 hours after the model was established, blood gas analysis was carried out in each group, oxygenation index (PaO2/FiO2) was calculated, and the levels of serum interleukins (IL-1, IL-6) were measured by enzyme linked immunosorbent assay (ELISA). Rats were sacrificed to harvest lung tissue, and the lung wet/dry ratio (W/D) was calculated; the morphological changes of lung tissue was observed under microscope; the superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were detected by colorimetry; the expression of tumor necrosis factor-α(TNF-α) in lung tissue was detected by immunohistochemical method. The correlations between lung W/D ratio and various indicators were analyzed using Pearson correlation test.Results Compared with the control group, PaO2/FiO2 in model group was significantly decreased, lung W/D ratio was significantly increased, serum IL-1, IL-6 levels and lung tissue MDA content were significantly increased, lung tissue SOD activity was significantly decreased; the alveolar space was filled with exudate, neutrophils and red blood cells, and there were obvious edema and broadening in pulmonary interstitial and alveolar under light microscope; the type Ⅱ alveolar epithelial cells were partly destroyed, accompanied by lamellar body degeneration and emptying phenomenon under electron microscope; and immunohistochemistry showed that the positive expression of TNF-α in lung tissue was significantly increased. Compared with the model group, PaO2/FiO2 in the treatment group was significantly improved [mmHg (1 mmHg = 0.133 kPa): 204.42±31.61 vs. 113.91±47.78,P < 0.05], the lung W/D ratio was significantly decreased (5.80±0.44 vs. 6.82±0.59,P < 0.01), serum IL-1, IL-6 levels and lung tissue MDA content were significantly decreased [IL-1 (μg/L): 18.38±0.28 vs. 20.04±0.39, IL-6 (μg/L): 12.64±0.67 vs. 14.28±1.33, MDA (nmol/mg): 3.95±0.28 vs. 5.17±0.29, allP < 0.05], the activity of SOD in lung tissue was significantly increased (U/mg: 48.75±2.41 vs. 45.09±1.69,P < 0.01), histological and pathological changes were significantly reduced, and the positive expression of TNF-α in lung tissue was significantly reduced [positive cell rate: (25.80±3.44)％ vs. (38.82±3.59)％,P < 0.01].Conclusion Penehyclidine hydrochloride can effectively improve the oxygenation, alleviate lung injury and reduce pulmonary edema in oleic acid induced ARDS rat by decreasing lung W/D ratio, inhibiting oxidative stress and inflammatory response.

In order to promote the integration between disciplines, the convergence between basic course and clinical teaching, increasing students ability including the active learning and life-long learning ability, finding problem and solving problem ability, teamwork spirit and so on. After nearly 3 years preparation, Hebei Medical University successfully carried out the PBL teaching in Seven-year Clinical Medicine Science. Combining with the teaching activities, formative assessment was carried out, and PBL teaching website was established. The reform has already achieved initial results, got good responds from teachers and students. Through the study, it has been confirmed that the PBL teaching method in Hebei Medical University is effective and worthy to reference.

Objective To explore the present situation of self-care ability among elderly hypertensive patients in the community and its influential factors.Methods 310 elderly hypertensive patients in Hengyang community were studied with a demographic questionnaire,ESCA and SSRS.Results The total mean scores of self-care ability were (105.43±19.25).68.71％ of the elderly hypertensive patients were at medium level and 29.35％ of them were at high level.Statistically significant relations were found between self-care ability and the following condition factors:education level,marital status,monthly income,obtaining health education status,social support,subjective support,availability,objective support and the severity of hypertension.There were no significant relations with sex and occupations.The results of multiple regression showed that the main factors ranged from high to low including the severity of hypertension,education level,monthly income,subjective support,obtaining health education status and marital status.Conclusions Community health nurses should aim directly at the influential factors,take effective measures and improve their self-care ability.

ObjectiveTo explore the effects of different doses of PcTx1,a specific blocker of acid-sensing ion channel 1a,on global cerebral ischemia/repedfusion (I/R) injury in rats,MethodsSixty adult male Sprague Dawley rats (weighing 250-300 g) were randomly divided into 6 grups ( n =10 each):sham operation group (group S),I/R group,different doses of PcTx1 ( 10 ng/ml,group P1 ; 25 ng/ml,group P2 ; 50 ng/ml,group P3 ;and 500 ng/ml,group P4 ) groups.Global cerebral ischemia was induced by the modified procedure of Pulsinelli 4-vessel occlusion.In groups P1,P2,P3 and P4,different doses of PcTx1 ( 10,25,50 and 500 ng/ml),6 μl each,were respectively injected into the lateral cerebral ventricle at the initiation of reperfusion,while equal volume of double distilled water was injected instead in group I/R.Six rats in each group were sacrificed at 24 h of reperfusion,and the brains were immediately removed,Thereafter,the contents of malondialdehyde (MDA),reduced glutathione (GSH) and ritric oxide (NO),the activities of constitutive NO synthase (eNOS) snd inducible NO synthase (iNOS) were detected in hippocampus.Four rats in each group were sacrificed at 72 h of reperfusion,and hematoxylin and eosin staining was used to observe the pathomorphological changes of the hippocampal neurons.ResultsCompared with group S,the other groups showed decreases in the contents of GSH,while increases in the contents of MDA and NO and the activities of cNOS and iNOS ( P ＜ 0.05 or 0.01 ).The contents of GSH increased,while the contents of MDA and NO and the activities of cNOS and iNOS decreased in groups P2,P3 and P4 compared with group I/R ( P ＜ 0.05 or 0.01).Compared with group P1,the contents of GSH increased,the contents of MDA and the activities of cNOS decreased in groups P2,P3 and P4,and the contents of NO and the activities of iNOS decreased in groups P3 and P4 ( P ＜ 0.05 or 0.01 ).Compared with group P2,the activities of iNOS decreased in groups P3 and P4(P ＜ 0.05 or 0.01).The damage to neurons in hippocampal CAI was severe in groups I/R and P1,but it was attenuated in groups P3 and P4.ConclusionPcTx1 25,50 and 500 ng/ml (6 μl)injected into lateral cerebral ventricle can attenuate global cerebral I/R injury in rats,and the dose 50 ng/ml (6 μl) is more suitable.

Objective To investigate the role of mitochondrial permeability transition pore (mPTP) of hippocampal neurons in process of hydrogen-rich saline attenuating global cerebral ischemia-reperfusion (I/R) injury in rats.Methods Seventy-two male Sprague Dawley rats,weighing 250-300 g,were randomly divided into six groups ( n =12 each):sham operation group (group S),cerebral ischemia-reperfusion group (group IR),normal saline group (group NS),hydrogen-rich saline group (group H),atractyloside group (group A) and hydrogen-rich saline + atractyloside group (group HA).Global cerebral I/R injury was produced by four-vessel occlusion method.Bilateral vertebral arteries were cauterized.Then bilateral common carotid arteries were occluded for 15min and followed by reperfusion.In groups H and HA,hydrogen-rich saline 5 ml/kg was injected intraperitoneally immediately after reperfusion,while equal volume of normal saline was injected in the other four groups.The rats in groups A and HA received intracerebroventricular injection of atractyloside 15 μl 10 min before reperfusion,while groups NS and H received intracerebroventricular injection of equal volume of normal saline.After the neurological behavior was evaluated at 24 h of reperfusion,8 rats in each group were sacrificed and the hippocampi were immediately isolated and homogenized followed by density gradient centrifugation.The opening degree of mPTP was assayed with spectrophotometry and the mitochondrial membrane potential (MMP) was detected with Rhodamine 123 method.Four rats in each group were killed at 72 h of reperfusion and the brains were removed for microscopic examination of the area CA1 of the hippocampus and determination of the number of normal pyramidal neurons.Results Compared with group S,the neurological behavior was compromised,MMP was decreased and mPTP opening degree was enhanced in the other five groups ( P ＜ 0.05).The neurological behavior was better,MMP was increased and mPTP opening degree was decreased in groups H and HA as compared with group IR ( P ＜ 0.05).Compared with group H,the neurological behavior was compromised,MMP was decreased and mPTP opening degree was enhanced in group HA ( P ＜ 0.05).Compared with group IR,the number of normal pyramidal neurons at 72 h of reperfusion in the CA1 region of the hippocampus was higher in group HA ( P ＜0.05).The injury of the CA1 region of the hippocampus at 72 h of reperfusion was attenuated in group H as compared with groups IR,NS,A and HA.Conclusion Hydrogen-rich saline can attenuate global cerebral I/R injury throngh inhibiting the mPTP opening and reducing the dissipation of MMP,thus maintaining the mitochondrial function.

Objective To investigate the role of acid-sensing ion channel 1a(ASIC1a) in global cerebral ischemia-reperfusion injury in rats.Methods Forty male SD rats weighing 250-300 g were randomly divided into 4 groups (n =10 each): sham operation group (group S),cerebral ischemia-reperfusion group (group I/R),solvent control group (group SC) and group PcTX1 (a ASIC1 a blocker,group P).Global cerebral ischemia-reperfusion was induced by four-vessel occlusion.PcTX1(500 ng/ml)6 μl or solvent 6 μl was injected into the crerbral ventricular at the begining of reperfusion in groups P and SC respectively.The rats were sacrificed at 24 h of reperfusion,and then the hippocampi were removed for determination of Caspase-3,Bcl-2 and Bax protein expression and microscopic examination.Results Compared with group S,the expression of Caspase-3,Bcl-2 and Bax protein was up-regulated in groups I/R,SC and P (P ＜ 0.05).Compared with group I/R,the expression of Caspase-3 and Bax was down-regulated,and the expression of Bcl-2 was up-regulated in group P ( P ＜ 0.05).There was no significant difference in Caspase-3,Bcl-2 and Bax protein expression between groups I/R and SC (P ＞ 0.05).The histopathologic damage was ameliorated in group P as compared with group I/R.Conclusion ASIC1a can induce global cerebral ischemia-reperfusion injury in rats by up-regulating Caspase-3 and Bax expression,and down-regulating Bcl-2 expression and inducing apoptosis.