Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with music biofeedback on insomnia.Methods:Sixty patients with insomnia who received treatment in Outpatient Department of Seventh People's Hospital of Dongyang from January to August 2021 were included in this study. They were randomly divided into an observation group ( n = 30) and a control group ( n = 30) using the random number table. The control group was given music biofeedback therapy and conventional drug treatment, and the observation group was treated with rTMS based on music biofeedback therapy. The changes in polysomnography sleep structure and Pittsburgh Sleep Quality Index score after 1 month of treatment relative to before treatment were determined in each group. Results:After 1 month of treatment, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep, non-REM sleep phase II (N2%) and non-REM sleep phase III (N3%) in the observation group were (419.87 ± 42.63) minutes, (83.69 ± 13.39)%, (25.27 ± 3.26)%, (53.75 ± 11.36)% and (16.27 ± 2.25)%, respectively, and they were (388.74 ± 40.39) minutes, (76.38 ± 13.17)%, (23.16 ± 2.68)%, (51.62 ± 12.27)%, and (14.36 ± 2.21)%, respectively. There were significant differences in these indices between the two groups ( t = -2.90, -2.13, -2.22, -2.26, -3.31, P = 0.005, 0.037, 0.030, 0.027, 0.002). The sleep latency, actual wake time, numbet of awakenings, non-REM sleep phase I (N1%), and total score of Pittsburgh Sleep Quality Index in the observation group were (24.16 ± 7.82) minutes, (23.18 ± 6.95) minutes, (1.76 ± 0.28) times, (9.74 ± 2.12)%, (9.17 ± 1.56) minutes, respectively. They were (28.35 ± 7.74) minutes, (28.36 ± 7.21) minutes, (2.25 ± 0.79) times, (11.12 ± 1.17)%, and (10.26 ± 1.42) minutes, respectively in the control group. There were significant differences in these indices between the two groups ( t = 2.09, 2.83, 3.20, 3.12, 2.83, P = 0.041, 0.006, 0.002, 0.003, 0.038). Conclusion:rTMS combined with music biofeedback for the treatment of insomnia can effectively improve sleep quality in patients with insomnia.

AIM: To find specific metabolic markers for women entering peri-menopausal period and patients with menopausal syndrome based on

Chaigui granules(CG)are a compound composed of six herbal medicines with significant antidepressant effects.However,the antidepressant mechanism of CG remains unclear.In the present study,we attempted to elucidate the antidepressant mechanism of CG by regulating purine metabolism and purinergic signaling.First,the regulatory effect of CG on purine metabolites in the prefrontal cortex(PFC)of chronic unpredictable mild stress(CUMS)rats was analyzed by ultra high-performance liquid chro-matography tandem mass spectrometry(UHPLC-MS/MS)targeted quantitative analysis.Meanwhile,purinergic receptors(P2X7 receptor(P2X7R),A1 receptor(A1R)and A2A receptor(A2AR))and signaling pathways(nod-like receptor protein 3(NLRP3)inflammasome pathway and cyclic adenosine mono-phosphate(cAMP)-protein kinase A(PKA)pathway)associated with purine metabolism were analyzed by western blotting and enzyme-linked immunosorbent assay(ELISA).Besides,antidepressant mecha-nism of CG by modulating purine metabolites to activate purinergic receptors and related signaling pathways was dissected by exogenous supplementation of purine metabolites and antagonism of puri-nergic receptors in vitro.An in vivo study showed that the decrease in xanthine and the increase in four purine nucleosides were closely related to the antidepressant effects of CG.Additionally,purinergic re-ceptors(P2X7R,A1R and A2AR)and related signaling pathways(NLRP3 inflammasome pathway and cAMP-PKA pathway)were also significantly regulated by CG.The results of exogenous supplementation of purine metabolites and antagonism of purinergic receptors showed that excessive accumulation of xanthine led to activation of the P2X7R-NLRP3 inflammasome pathway,and the reduction of adenosine and inosine inhibited the A1R-cAMP-PKA pathway,which was significantly ameliorated by CG.Overall,CG could promote neuroprotection and ultimately play an antidepressant role by inhibiting the xanthine-P2X7R-NLRP3 inflammasome pathway and activating the adenosine/inosine-A1R-cAMP-PKA pathway.

Objective To investigate the expressions of Th17 lymphocytes and interleukin-17 (IL-17) in peripheral blood of patients with non-small cell lung cancer (NSCLC) and its clinical significance. Methods Sixty patients with primary and untreated NSCLC were enrolled and designed as experimental group, at the same time, 60 healthy volunteers were collected as control group. Flow cytometry (FCM) was used to detect the level of Th17 lymphocytes. Enzyme linked immunosorbent assay (ELISA) was used for detecting the level of IL-17. The relationship between the expression levels of Th17 and IL-17 in peripheral blood and clinicopathological features was compared between the two groups. Results The peripheral blood levels of Th17 lymphocytes and IL-17 in the experimental group [(1.7±1.2) ％, (8.3±2.5) pg/ml] were higher than those in the control group [(0.9 ±0.6) ％, (5.4 ±1.2) pg/ml] (P< 0.05). The peripheral blood expression of Th17 lymphocytes and IL-17 in patients with smoking history [(1.8±1.2) ％, (8.8±3.7) pg/ml] were higher than those in patients without smoking history [(1.6±1.2)％, (8.0±2.2) pg/ml], and the peripheral blood expression of Th17 lymphocytes and IL-17 were higher in patients with squamous-cell carcinoma [(1.8 ±1.2) ％, (9.4 ±4.7) pg/ml] than those in patients with adenocarcinoma [(1.6±1.1) ％, (7.3±3.9) pg/ml], furthermore, they were also higher in patients with stage Ⅲ-Ⅳ than those in patients with stage Ⅰ-Ⅱ (P < 0.05). Conclusion Th17 lymphocytes and IL-17 play certain roles in the occurrence and progression of NSCLC.

Objective To analyze the dynamic flow of pediatricians from 2010 to 2015, their present deployment and workload as compared with physicians across the country, in order to provide reference for their effective allocation.Methods Selecting data indexes from Chinese Statistical Yearbook and China Health and Family Planning Yearbook, and using Excel for statistics of relevant index data.By means of horizontal and vertical comparisons, a dynamic analysis was made on such indexes as the number of pediatricians, that of pediatricians per thousand children, and the number of hospital admissions and the number of hospitalizations per pediatrician.Results The total of pediatricians only increased by 2.32% from 2010 to 2015.On the other hand, the number of pediatricians per thousand population only accounted for 23.42% of physicians per thousand population in 2015.These five years witnessed a 40.58% workload increase of outpatient/emergency visits per pediatrician, and 36.70% increase of discharged inpatients.Conclusions China is faced with the challenges of shortage and insufficient supply of pediatricians, worsened by excessive workloads.It is advisable to improve pediatrician development pattern, raise their remuneration, and ease their workload, for the sake of better healthcare for children.

Aim To explore the effect of activated SK channels(small conductance Ca2+-activated K+ channels) on morphine-induced hyperalgesia in the spinal cord in mice.Methods Adult C57BL6/N male mice were chosen to establish the model of morphine-hyperalgesia.The changes of tail withdrawal latency(TWL), mechanical withdrawal threshold(MWT) and the threshold of visceral pain were observed after intrathecal 1-EBIO, the agonist of SK channels.Results Compared with the control group, TWL, MWT and the threshold of visceral pain were decreased after morphine injection.After intrathecal 1-EBIO, the TWL, MWT and visceral pain threshold were increased.The level of spinal membrane SK2 expression in morphine-treated mice was decreased compared with that of control group.After intrathecal 1-EBIO, the level of spinal membrane SK2 expression was increased.Conclusion SK channels in the spinal cord are involved in morphine-induced hyperalgesia in mice.

Objective To evaluate the clinical effect of popliteal artery perforator-based sural neurovascular flap for repairing soft tissue defects in middle and distal upper leg.Methods Between December,2011 to September,2015,18 cases with skin soft tissue defects on the middle and distal upper leg were treated with popliteal artery perforator-based sural neurovascular flap,in which 12 cases were males,and 6 cases were females.The age was from 24 to 55 years,with the average age of 35.9 years.The size of tissue defects ranged from 3.0 cm × 3.0 cm to 7.0 cm × 9.0 cm.Results All flaps survived completely in 18 cases,1 case of marginal infection heated after dressing,and the rest cases in Ⅰ healing.The outline and function of survived flap were satisfactory during 3-16 months follow-up,with two-point discrimination of 4.0-10.0 mm.Conclusion The anterograde sural neurovascular flap based on the popliteal artery perforator provides a practical option for covering tissue defects in middle and distal upper leg.This flap is characteristiced by reliable blood supply without sacrificing main vesses,good contour and texture,in addition,the operation is easy of handling.

OBJECTIVETo investigate the relationship between acute graft rejection early after renal transplantation and the variations of platelet parameters.

METHODSWe retrospectively analyzed the clinical data of 167 renal transplant recipients before and within 2 months after the surgery. Before and at 1-10 days, 15 days, 30 days, 45 days and 60 days after the transplantation, 5 platelet parameters, including platelet count (PLT), platelet hematocrit (PCT), mean platelet volume (MPV), platelet volume distribution width (PDW), and large platelet ratio (P-LCR), were detected in the 35 patients with acute graft rejection within two months (AR group) and in the other 132 recipients with good graft recovery (control group).

RESULTSThe AR group and control group showed no significant difference in PLT, PCT, MPV, or P-LCR before the surgery, but the PDW was significantly higher in the AR group (t=2.18, P=0.035). These parameters were similar within 5 postoperative days between the two groups (P>0.05), but in postoperative days 6-15, the AR group showed significantly increased MPV, PDW and P-LCR compared with the control group (P<0.05). In postoperative days 6-9, MPV, PDW and P-LCR became stable in AR group but tended to decrease in the control group, showing obviously different patterns of variation between the two groups (P<0.05).

CONCLUSIONSPreoperative PDW may have a positive correlation with acute graft rejection after renal transplantation. Monitoring the variations of MPV, PDW and P-LCR may help in the diagnosis of acute graft rejection early after renal transplantation.

Objective To explore the application of the ultraviolet spectrophotometry method in detecting colchicine poisoning serum to provide the basis for clinical diagnosis and treatment of colchicine poisoning.Methods 0.5 mL of serum was taken and added with the extract solution(chloroform∶methanol=95 ∶5)4.0 mL.The sufficient oscillation extraction and high-speed cen-trifugation were performed.Then the organic layer was taken into another test tube for drying by nitrogen.0.2 mL of methanol dis-solved residue was taken and blended.50 μL of the mixed solution was taken for conducting ultraviolet scanning.Results The max-imum absorption peak of serum colchicine was (351 ±1)nm,the concentration within 5.0-40 μg/mL showed linearity,the regres-sion equation wasY =0.050 2X +0.001 3,the correlation coefficient was 0.999 5,the recovery rate was 83.8% -102.8%,the rel-ative standard deviation:3.3% -4.8%.The intra-day and inter-day were 3.22%-4.74% and 3.45%-4.66%,the lowest detec-tion concentration was 1 .0 μg/mL.Conclusion This method is simple to operate,fast in analysis,accurate in the detection result, which provides a simple and accurate detection method for clinical diagnosis of colchicine poisoning.

Objective To investigate the relationship between acute graft rejection early after renal transplantation and the variations of platelet parameters. Methods We retrospectively analyzed the clinical data of 167 renal transplant recipients before and within 2 months after the surgery. Before and at 1-10 days, 15 days, 30 days, 45 days and 60 days after the transplantation, 5 platelet parameters, including platelet count (PLT), platelet hematocrit (PCT), mean platelet volume (MPV), platelet volume distribution width (PDW), and large platelet ratio (P-LCR), were detected in the 35 patients with acute graft rejection within two months (AR group) and in the other 132 recipients with good graft recovery (control group). Results The AR group and control group showed no significant difference in PLT, PCT, MPV, or P-LCR before the surgery, but the PDW was significantly higher in the AR group (t=2.18, P=0.035). These parameters were similar within 5 postoperative days between the two groups (P>0.05), but in postoperative days 6-15, the AR group showed significantly increased MPV, PDW and P-LCR compared with the control group (P<0.05). In postoperative days 6-9, MPV, PDW and P-LCR became stable in AR group but tended to decrease in the control group, showing obviously different patterns of variation between the two groups (P<0.05). Conclusions Preoperative PDW may have a positive correlation with acute graft rejection after renal transplantation. Monitoring the variations of MPV, PDW and P-LCR may help in the diagnosis of acute graft rejection early after renal transplantation.