Objective:To investigate the symptoms and symptom clusters of elderly stroke patients in the acute phase, analyze the factors influencing the symptom clusters and to provide a basis for the implementation of targeted symptom management in elderly stroke patients.Methods:Convenience sampling method was used to select 257 acute-phase elderly stroke patients who attended Fenyang Hospital in Shanxi Province from October 2022 to January 2023, and a cross-sectional survey was conducted by the General Information Questionnaire, Memory Symptom Evaluation Inventory, Modified Barthel Index Scale (MBI), and the National Institutes of Health Stroke Scale (NIHSS), and the symptom clusters were extracted by means of exploratory factor analysis, and the factors influencing symptom clusters were explored by means of binary logistic regression analysis.Results:Of the 257 patients, 138 were male and 119 were female, aged 60 to 90 (70.34 ± 6.94) years old. Factor analysis yielded four symptom clusters, which were named oral-intestinal symptom cluster, negative emotional symptom cluster, fatigue symptom cluster, and perceptual symptom cluster according to the symptom characteristics; regression analysis showed that: stroke site and NIHSS scores were the influencing factors of the oral-intestinal symptom cluster (all P<0.05); per capita monthly family income, number of episodes and MBI scores were the influencing factors of the negative emotional symptom cluster (all P<0.05); number of chronic diseases, type of stroke, and gender were the influencing factors of the fatigue emotional symptom cluster (all P<0.05); and literacy and stroke site were influencing factors of the perception symptom cluster (all P<0.05). Conclusions:Elderly stroke patients in the acute phase of the existence of more symptoms, symptoms interact with each other to form symptom clusters, health care personnel should be symptom clusters as a unit, the implementation of interventions for their influencing factors, effective symptom management, in order to improve the quality of life of patients.

Objective To investigate the genetic causes of auditory neuropathy with optic atrophy in a family.Methods The proband's medical history and family history were inquired in detail,and relevant clinical examina-tions were performed to confirm the diagnosis of auditory neuropathy with optic atrophy,and the genetic pedigree of the family was drawn.Peripheral blood of proband(Ⅲ-7)was collected for whole exome sequencing,and the patho-genicity of the detected mutations were interpreted.Blood samples of proband's wife(Ⅲ-8),eldest daughter(Ⅳ-7),second daughter(Ⅳ-9)and son(Ⅳ-10)were tested for mutation sites by Sanger sequencing.Combined with clinical manifestations and examination results,the family was studied.Results The genetic pattern of this family was autosomal dominant.The proband showed decreased visual acuity at the age of 19,bilateral sensorineural deaf-ness at the age of 30,and decreased speech recognition rate.Among 20 members of the family of 5 generations,10(2 deceased)showed similar symptoms of hearing and visual impairment.Proband(Ⅲ-7),eldest daughter(Ⅳ-7)and son(Ⅳ-10)underwent relevant examination.Pure tone audiometry showed bilateral sensorineural deafness.ABR showed no response bilaterally.The 40 Hz AERP showed no response in both ears.OAE showed responses in some or all of the frequencies.No stapedial reflex was detected.The eye movement of Ⅲ-7 and Ⅳ-10 were reasona-ble in all directions,and color vision was normal.Ocular papilla atrophy was observed in different degrees in fundus examination.OCT showed thinning of optic disc nerve fibers in both eyes,and visual evoked potential showed pro-longed P100 wave peak.They were diagnosed as hereditary auditory neuropathy with optic atrophy.A mutation of the OPA1 gene c.1334G＞A(p.Arg445His,NM_015560.2)at a pathogenic locus on chromosome 3 was detected by whole exon detection in Ⅲ-7.The results of generation sequencing analysis showed that the OPA1 gene c.1334G＞A(p.Arg445His,NM_015560.2)mutation of chromosome 3 was also found in Ⅳ-7 and Ⅳ-10.Meanwhile,the gen-otypes of Ⅲ-8 and Ⅳ-9 were wild homozygous,that is,no mutation occurred.Conclusion The OPA1 c.1334G＞A(p.Arg445His,NM_015560.2)mutation site might be the pathogenic mutation in this family.

Objective:To retrieve, evaluate and summarize the best evidence for the assessment and non-pharmacological management of chemotherapy-induced peripheral neuropathy.Methods:The literature related to the assessment and non-pharmacological management of chemotherapy-induced peripheral neuropathy was systematically searched from January 1, 2018 to December 4, 2023 in clinical decision support systems, guideline networks, databases and related society websites at home and abroad, including clinical decision-making, guidelines, expert consensus, evidence summary, systematic review, and randomized controlled studies. Four reviewers evaluated the quality of the included studies and extracted evidence.Results:A total of 18 articles were included, including 1 clinical decision, 2 guidelines, 3 expert consensuses, 5 evidence summaries, 4 systematic reviews, and 3 randomized controlled studies. A total of 21 pieces of evidence were summarized from 7 items: assessment, exercise therapy, acupuncture therapy, cryotherapy, compression therapy, health education, and multidisciplinary diagnosis and treatment.Conclusions:Non-pharmacological intervention is an effective means to improve chemotherapy-induced peripheral neuropathy. Medical personnel should combine professional judgment with patient′s will, prudently, wisely and clearly use the best evidence to prevent or reduce chemotherapy-induced peripheral neuropathy and improve patients′ quality of life.

Objective This study aimed to identify PAX9 variants in non-syndromic tooth agenesis families of Chi-na,as well as to analyze the genotype-phenotype of non-syndromic tooth agenesis caused by PAX9 variants,which can provide a basis for the genetic diagnosis of tooth agenesis.Methods We collected the data of 44 patients with non-syn-dromic oligodontia who underwent treatment at Stomatological Hospital of Hebei Medical University between 2018 and 2023.Whole-exome sequencing was performed on the peripheral blood of the proband and its core family members,and the variants were verified by Sanger sequencing.Pathogenicity analysis and function prediction of the variants were per-formed using bioinformatics tools.The correlation between the genotype of PAX9 variant and its corresponding pheno-type was examined by reviewing 55 publications retrieved from PubMed.The studies involved 232 tooth agenesis pa-tients with PAX9 variants.Results A novel PAX9 c.447delG(p.Pro150Argfs*62)and a reported PAX9 c.406C>T(p.Gln136*)were identified in two Chinese families.Through bioinformatics analysis and three-dimensional structural mod-eling,we postulated that the frameshift variant was pathogenic.The outcome was the premature cessation of PAX9 pro-tein,which caused severe structural and functional deficiencies.Summarizing the PAX9 genotype-phenotype relationship revealed that patients carrying the PAX9 variant commonly led to loss of the second molars.Conclusion We identified the novel PAX9 c.447delG(p.Pro150Argfs*62)in a Chinese family of non-syndromic oligodontia,expanding the known variant spectrum of PAX9.The most susceptible tooth position for PAX9 variants of tooth agenesis was the second mo-lars and the deciduous molars during the deciduous dentition.

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.

Objective:To identify the key convergence points in the medical-nursing combined care among literature, and establish a mechanism for medical-nursing combined care integration from the perspective of the synergy theory, for the purpose of promoting the integrated development of such care in China.Methods:Relevant literature on the medical-nursing combined care were retrieved from the CNKI database from September 2013 to September 2021. The search formula used was TI= "the medical-nursing care integration" AND SU=(convergence+ transformation+ coordination+ mechanism), while supplementary searches were made using " pkulaw.com database" and Baidu Scholar database. The method of literature content analysis was used to screen key points of the medical-nursing combined care, and the convergence mechanism was built based on the perspective of the synergy theory.Results:A total of 42 literatures were included in this study, 8 key convergence points of medica-nursing combined care integration were identified. Namely the 4 key horizontal convergence points of medical care, aging care, rehabilitation and nursing, the 3 key vertical convergence points of home care, institution care and community care, and the one key convergence point of institutional medical care. Based on the synergy theory and the 8 key convergence points, the " 431" convergence mechanism of medical-nursing combined care was constructed. This mechanism refered to the horizontal linkage of healthcare, nursing, rehabilitation and aging care, the vertical redirection among home care, institution care and community care modes, and the development mode focusing on institutional aging care.Conclusions:At present, the poor convergence between aging care and nursing care in China is a key roadblock hindering the integrated development of aging and nursing care. Medical-nursing combined care should be conducive to the " 431" convergence development, achieving horizontal linkage, vertical redirection, and resource sharing, for the purpose of high-quality development of China′s aging care system.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, characterized by highly hypoxic tumor microenvironment. Hypoxia-inducible factor-1α (HIF-1α) is a major regulator involved in cellular response to changes of oxygen levels, supporting the adaptation of tumor cells to hypoxia. Bruceine D (BD) is an isolated natural quassinoid with multiple anti-cancer effects. Here, we identified BD could significantly inhibit the HIF-1α expression and its subsequently mediated HCC cell metabolism. Using biophysical proteomics approaches, we identified inhibitor of β-catenin and T-cell factor (ICAT) as the functional target of BD. By targeting ICAT, BD disrupted the interaction of β-catenin and ICAT, and promoted β-catenin degradation, which in turn induced the decrease of HIF-1α expression. Furthermore, BD could inhibit HCC cells proliferation and tumor growth in vivo, and knockdown of ICAT substantially increased resistance to BD treatment in vitro. Our data highlight the potential of BD as a modulator of β-catenin/HIF-1α axis mediated HCC metabolism.

OBJECTIVE：To establish the content determination me thod of 3 mono/disaccharides in 3 kinds of medicinal Dendrobii Caulis. METHODS ：HPLC-CAD method was established. The determination was performed on Shodex Asahipak NH2P-50 4E column with mobile phase consisted of acetonitrile-water （75 ∶ 25，V/V）at the flow rate of 1.0 mL/min. The column temperature was set at 30 ℃，and sample size was 10 µL. CAD detection condition included that data acquisition frequency was 5 Hz，filter constant was 5 s，atomization temperature was 35 ℃ ，gas source was nitrogen with pressure of 4.012 × 105 Pa. RESULTS：The linear range of fructose ，D-anhydrous glucose and sucrose were 0.156 2-1.873 8 mg/mL（r＝0.999 5），0.012 7- 0.152 4 mg/mL（r＝0.999 7），0.277 6-3.331 2 mg/mL（r＝0.999 8），respectively. The limits of quantification were 0.002 61，0.004 24 and 0.005 12 mg/mL，and the limits of detection were 0.000 78，0.001 27 and 0.001 54 mg/mL，respectively. RSDs of precision ， stability，reproducibility and durability tests were all lower than 3％. The recoveries were 95.98％-98.15％（RSD＝0.83％，n＝6）， 95.64％-98.62％（RSD＝1.10％，n＝6）and 97.53％-98.94％（RSD＝0.53％，n＝6）. The contents of them were 0.28％-1.12％， 0.02％-0.13％，0.76％-2.67％，respectively. The total content was 1.38％～3.10％. The order of saccharide content in 3 kinds of Dendrobii Caulis was sucrose ＞fructose＞D-anhydrous glucose ；the order of sucrose content and total content were Dendrobium huoshanense＞D. moniliforme ＞D. officinale ；the order of D-anhydrous glucose content was D. huoshanense ＞D. officinale ＞D. moniliforme； the order of fructose content was D. moniliforme ＞D. officinale ＞D. huoshanense . CONCLUSIONS ：Established method is sensitive ，reproducible and simple in operation ，and can be used for content determination of 3 saccharides in 3 kinds of medicinal Dendrobii Caulis. There are differences in the contents of saccharide s among 3 kinds of Dendrobii Caulis.

Objective:To explore influence on physical development of children aged 18 months from HIV-positive mothers for prevention mother to child transmission of HIV (PMTCT) in Guangxi Zhuang autonomous region, and provide evidence for the improvement PMTCT program.Methods:This retrospective case control study was conducted in 554 HIV negative infants aged 18 months whose HIV positive mothers had received PMTCT services reported through PMTCT system database from January 1, 2010 to December 31, 2017 and 1 109 healthy infants born in 2017, whose mothers were healthy, in Lingshan, Luzhai, and Hengxian counties, ranking top three counties with high HIV infection prevalence, in Guangxi. PMTCT data and physical development data such as height, weight and head circumference of children aged 18 months were collected. The physical dysplasia in the infants was defined as at least one of the three main indicators of height, weight and head circumference below the normal range.Results:The number of HIV-positive mother and their infants in the case group were 667 and 554 respectively, and the PMTCT rates were 91.15 % (608/667) and 96.57 % (535/554) respectively. HIV positive rate, mortality rate and mother to child transmission rate of the infants aged 18 months were 1.44 % (8/554), 3.07 % (17/554) and 1.91 % (8/418) respectively, and the physical examination results of the infants aged 18 months showed that the physical dysplasia rate was 30.51 % (169/554). Among the 1 109 infants in the control group, the physical dysplasia rate was 9.83 % (109/1 109). The difference between the case group and the control group was significant ( P<0.01). Conclusion:The PMTCT rates of HIV positive mother and their children were more than 90.00 %, respectively. However, poor physical development rate of infants aged 18 months were more than 30.00 %. The possible influence of PMTCT on physical development of the infants aged 18 months of HIV positive mother’s needs to be further studied.

Objective To describe and analyze the status quo of the doctor and nurse configuration in Heilongjiang Province,and to study their cultivation condition while predicting the number of medical staff.Methods Through the health workforce database of Heilongjiang Province in 2014,using Excel 2007 statistical software,the status quo of doctor and nurse configuration was analyzed.The grey prediction model was also used to analyze the number of medical staff in Heilongjiang province from 2004 to 2014,and the number of medical staff in Heilongjiang province from 2016 to 2018 was predicted.Results Up to 2015,the number of doctors and nurses in Heilongjiang Province accounted for 0.42％ of the total population,composed of mainly young and middle-aged staff and mostly with bachelor's degree and junior college certificate.Doctor-to-nurse ratio was 1:0.96.The grey prediction model indicated that the number of medical staff in Heilongjiang Province would increase year by year,and the inversion of doctor-to-nurse ratio would be eased.Conclusion The reform and development of medical education in Heilongjiang Province has promoted the optimization of the professional title structure and educational structure.It is expected that by 2016 Heilongjiang medical care ratio inversion problem will be completely resolved.