Objective:To develop a professional grief scale for medical postgraduate students(PGS-MPS) and test its reliability and validity.Methods:Based on the integrated model of professional grief, the initial item pool was formed after literature analysis, semi-structured interviews, group discussion, and 5 experts were invited to assess the relevance of the items and provided revision suggestion.A total of 506 valid questionnaires were collected.SPSS 25.0 and AMOS 26.0 were used to test its reliability and validity.Results:The PGS-MPS included 41 items, including the professional grief reaction subscale and disenfranchised grief subscale.The professional grief reaction subscale included emotional reaction (14 items), physiological and cognitive reaction (20 items), and the cumulative variance contribution rate of the two factors model was 52.908%.Disenfranchised grief subscale included 7 items, with a single dimension and a variance contribution rate of 51.730%.Confirmatory factor analysis indicated the model fitting well.The Cronbach’s α coefficients for the professional grief reaction subscale and disenfranchised grief subscale were 0.947 and 0.850, respectively.Conclusion:The PGS-MPS has good reliability and validity and can be used to evaluate professional grief of medical postgraduate students.

Objective:To explore the prolonged therapeutic regimen for patients with plaque psoriasis, who showed a positive response to 4-week treatment with tazarotene/betamethasone dipropionate cream, but were not completely cured.Methods:A multicenter, randomized, open-labelled, parallel-controlled clinical study was conducted. A total of 232 patients with plaque psoriasis were collected, who showed a positive response to previous 4-week treatment with 0.05%/0.05% tazarotene/betamethasone dipropionate cream, but were not completely cured with the psoriasis area and severity index[PASI] improvement rate being 50%-90%. At week 5, they were randomly and equally divided into 2 groups: test group receiving treatment with 0.05%/0.05% tazarotene/betamethasone dipropionate cream once a day, and control group receiving a sequential regimen of 0.05% tazarotene gel on weekdays once a day followed by 0.05%/0.05% tazarotene/betamethasone dipropionate cream on weekends once a day. After 2-and 4-week prolonged treatment, the efficacy and safety of the 2 therapeutic regimens were evaluated and compared. Measurement data were compared between 2 groups by using covariance analysis or t test, and enumeration data were compared by using chi-square test. Results:From the 5th to the 8th week, 200 out of the 232 patients completed the treatment. Data collected from 110 patients in the test group and 112 in the control group were enrolled into the full analysis set, and those from both 113 patients in the test group and control group were enrolled into safety analysis set. After consecutive 6-and 8-week treatment, the decline rates of the PASI score were 73.05% ± 16.69% and 78.46% ± 15.40% respectively in the test group, which were significantly higher than those in the control group (66.73% ± 21.77%, 67.02% ± 34.19%, respectively, both P < 0.05) . After 6-week treatment, the proportion of subjects who achieved PASI90 was significantly higher in the test group (14 cases, 12.7%) than in the control group (5 cases, 4.5%, χ2=4.842, P=0.028) ; After 8-week treatment, the proportions of subjects who achieved PASI75 and PASI90 (61.8%, 23.6%, respectively) were significantly higher in the test group than in the control group (48.2%, 12.5%, respectively, both P < 0.05) . During the consecutive 8-week treatment, there was no significant difference in the incidence rate of adverse reactions between the test group (15.0%) and control group (23.9%, χ2=2.822, P=0.093) . Conclusion:For patients who showed a positive response to 4-week treatment with 0.05%/0.05% tazarotene/betamethasone dipropionate cream, but were not completely cured, the continuous use of 0.05%/0.05% tazarotene/betamethasone dipropionate cream for 4 weeks is a superior therapeutic regimen compared with the sequential regimen of 0.05% tazarotene gel followed by 0.05%/0.05% tazarotene/betamethasone dipropionate cream.

Objective:To search and summarize the best evidence for blood pressure management in patients with intracerebral hemorrhage to provide evidence for blood pressure management in these patients.Methods:PIPOST model was used to establish evidence-based questions; with "intracerebral hemorrhage/cerebral hemorrhage/ICH/HICH/stroke" AND "blood pressure/hypertension" as English search terms, and with "脑出血/颅内出血/脑卒中"+"血压" as Chinese search terms, the official websites of related associations and domestic and foreign databases, such as GUIDE.com, UpToDate, Cochrane Library, CNKI, VIP Chinese journal Service platform, and Wanfang Data Knowledge Service platform, were searched. Two researchers independently evaluated the quality of the literature, including guidelines, systematic reviews, and expert consensus, and extracted the evidence.Results:A total of 17 articles were selected; 2 were clinical decision type, 7 were guideline type, 7 were systematic review type, and 1 was expert consensus type. Twenty-six pieces of evidence were summarized into 5 aspects: timing and methods of lowering blood pressure, benefits and risks of lowering blood pressure, drug selection and selection methods, recurrence prevention of stroke, and matters for attention.Conclusion:It is necessary to pay attention to blood pressure management in patients with intracerebral hemorrhage; in the process of evidence application, it's suggested to make an appropriate blood pressure management plan for the patients according to clinical situation.

Objective: To evaluate the clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic (HMME-PDT) therapy for the treatment of port-wine stain (PWS) and its sonographic changes. Methods: A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology, Third Affiliated Hospital of Soochow University from March 2017 to June 2018, including 5 with pink PWS, 39 with purplish red PWS and 1 with thickened PWS. All the patients received 3 sessions of HMME-PDT therapy. The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound. Ranked data were analyzed by using nonparametric test. Measurement data were expressed as mean ± standard deviation, and analyzed using ony-way analysis of variance. Multiple comparisons were performed using Student-Newman-Keuls-q (SNK-q) test. The results were considered to be statistically significant if P < 0.05. Results: Among the 45 patients with PWS who completed the treatment and follow-up, 10 were cured, 21 received marked improvement, 12 received improvement, and 1 showed no response. The total response rate was 97.78%, and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS (U = 12.50, P < 0.001) . The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients, patients receiving marked improvement and those receiving improvement (skin thickness:0.65 ± 0.21, 0.56 ± 0.88, 0.37 ± 0.12 mm respectively; skin density: -8.65 ± 2.19, -6.86 ± 2.79, -4.92 ± 2.91 g/cm³ respectively; F = 14.528, 5.428 respectively, both P < 0.001) , and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement (q = 5.82, 4.63, both P < 0.05) . Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy, but gradually regressed about 1 week later. Pale brown crusts were observed at the laser-exposed sites in 35 patients, and shed spontaneously about 3 weeks later. Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients, and gradually regressed after 2-month follow-up. Conclusions HMME-PDT therapy is effective for the treatment of PWS, with high safety and few adverse reactions. High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.

OBJECTIVE: Whether blood-brain barrier (BBB) disruption induced by chronic spontaneous hypertension is associated with beta-amyloid (Aβ) accumulation in the brain remains poorly understood. The purpose of this study was to investigate the relationship between BBB disruption and Aβ influx and accumulation in the brain of aged rats with chronic spontaneous hypertension. MATERIALS AND METHODS: Five aged spontaneously hypertensive rats (SHRs) and five age-matched normotensive Wistar-Kyoto (WKY) rats were studied. The volume transfer constant (Ktrans) obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was used to evaluate BBB permeability in the hippocampus and cortex in vivo. The BBB tight junctions, immunoglobulin G (IgG), Aβ, and amyloid precursor protein (APP) in the hippocampus and cortex were examined with immunohistochemistry. RESULTS: As compared with WKY rats, the Ktrans values in the hippocampus and cortex of the SHRs increased remarkably (0.316 ± 0.027 min−1 vs. 0.084 ± 0.017 min−1, p < 0.001 for hippocampus; 0.302 ± 0.072 min−1 vs. 0.052 ± 0.047 min−1, p < 0.001 for cortex). Dramatic occludin and zonula occludens-1 losses were detected in the hippocampus and cortex of SHRs, and obvious IgG exudation was found there. Dramatic Aβ accumulation was found and limited to the area surrounding the BBB, without extension to other parenchyma regions in the hippocampus and cortex of aged SHRs. Alternatively, differences in APP expression in the hippocampus and cortex were not significant. CONCLUSION: Blood-brain barrier disruption is associated with Aβ influx and accumulation in the brain of aged rats with chronic spontaneous hypertension. DCE-MRI can be used as an effective method to investigated BBB damage.
Alzheimer Disease ; Amyloid ; Animals ; Blood-Brain Barrier* ; Brain* ; Hippocampus ; Hypertension* ; Immunoglobulin G ; Immunohistochemistry ; Magnetic Resonance Imaging* ; Methods ; Occludin ; Permeability ; Rats* ; Rats, Inbred SHR ; Rats, Inbred WKY ; Tight Junctions

Objective To compare the influence of different coating materials and cultural conditions on the purification and growth of human epidermal melanocytes. Methods The full-thick foreskin, epidermis and cell suspension obtained from human foreskin were cultured in the plates, which were precoated with matrigel or laminin respectively. When having reached 80%-90%confluence, the cells were treated with 0.05%trypsin-EDTA for 4 minutes and resuspended in M254 medium, which were supplemented with G418 and 5-BrdU, respectively. The purity of melanocytes was observed by an immunofluorescence staining with melanocyte markers. Results During the primary culture, the cell suspension generated more cells at faster speed compared with those of skin explants and epidermal specimen. Moreover, the epidermis released cells earlier and proliferated quickly over skin explants. The melanocytes in the plates coated with laminin other than with matrigel displayed faster and better growth. The unwanted keratinocytes and fibroblasts were removed by using differentiation trypsinition combined with supplement of G418 or 5-BrdU. Conclusion Using a plate coated with laminin to culture cell suspension from human foreskin, and via a differentiation trypsinization combined with supplement of small doses of G418 to subculture the cells, is advantageous to the melanocyte purification, without affecting their growth.

OBJECTIVETo explore the safety and efficacy of Shaobei injection in the management of I(-II( degree rectal prolapse.

METHODSA total of 80 patients eligible for the inclusion criteria were divided into 2 groups: 40 patients in the treatment group (treated with Shaobei injection) and 40 cases in the control group (treated with Xiaozhiling) respectively. The short-term efficacy was identified by the length of rectal prolapse and the depth of rectocele demonstrated by the defecography while the long-term efficacy was evaluated by the length of rectal prolapse. In addition, the safety was assessed by the occurrence of postoperative complications.

RESULTSThe variation of the lengths of rectal prolapse and the depth of rectocele demonstrated by the defecography at the sixth month follow up in the two groups did not reach significant difference (P>0.05). After 2 year follow up, 37 patients (92.5%) in the treatment group and 35 cases(87.5%) in the control group was cured. Therefore, there was no significant difference in the long term efficacy between the two groups (P>0.05). The adverse events in the therapy group(10%) was less than that in the control group (45%)(P<0.01).

CONCLUSIONSShaobei injection in the management of I(-II( degree rectal prolapse has a similar efficacy of short-term and long-term higher safety compared to Xiaozhiling injection.

Objective To investigate the characteristics of diet in patients with gestational diabetes mellitus(GDM) and analyze their dietary nutrition.Methods Clinical data of 978 cases of pregnant women in our hospital were collected and divided into GDM group(458 cases) and the healthy control group (520 cases).Dietary questionnaire was designed and diet characteristics were analyzed retrospectively.Daily calories and nutrients intake were calculated by software calculation.Results There were significant differences on the dietary pattern between the two groups:daily coarse grains:(35.12 ±4.87) g vs (46.35 ±5.23) g;seafood:(22.10 ± 8.45) g vs (39.34 ± 12.45) g;grilled:(6.72 ± 1.76) g vs (3.45 ±0.34) g;fried:(25.34 ± 7.84)g vs (10.56 ±4.76) g;sausage:(5.38 ± 1.81) g vs (3.45 ± 0.45) g;dessert type products intake:(50.41 ±20.76) g vs (35.86 ± 10.45) g (t =2.582,10.346,15.452,20.239,18.195,8.472,respectively,P ＜0.05).There was only significant difference between the two groups on calcium supplements in daily intake of nutritional supplements(GDM group 43.89％,control group 72.69％,x2 =83.660,P ＜ 0.001),and there was no significant difference on the rests(all P ＞ 0.05).Vitamin A,B1,B2,C and calcium,iron,zinc,selenium daily intake in GDM patients were less than those in the control group,but there was significant difference only in calcium compared with the control group (GDM group (785.2 ± 194.5) mg,control group (945.5 ± 245.2)mg,t =2.795,P =0.005).Multivariate logistic regression found that excessive intake of fried class (OR =3.357,95％ CI =2.012-11.340),barbecue (OR =2.652,95％ CI =1.834-8.578),sausage type products (OR =2.518,95％ CI =1.743-7.421) etc.were dietary factors of GDM (all P ＜ 0.05).Incidence of GDM was significantly increased if taking more.While the increased intake of coarse grains (OR =0.632 95％ CI =0.134-1.489),seafood class(OR =0.408,95％ CI =0.105-1.189) can reduce the occurrence of GDM(all P ＜ 0.05).Conclusion Many unscientific ways of eating involved in pregnant women with GDM.Dessert,sausage,grilled,fried products intake increased the risk factors for GDM.Coarse grains,seafood intake were the protective factors of GDM.Timely adjustment of maternal diet and adequate calcium supplementation played an important role in the prevention of GDM.

Objective To investigate the pathological types and features of lymph nodes in human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)patients with superficial lymphadenectasis.Methods The tissues of lymph nodes were obtained from 151 HIV/AIDS patients with superficial lymphadenectasis for pathological examination.The pathological results were observed by light microscope after Hematoxylin-Eosin(HE),acid-fast,periodic acid-Schiff (PAS),and digested-PAS(D-PAS)staining.The pathological results of lymph nodes were described and the correlation between pathological changes and CD4+T lymphocyte count was analyzed.Chisquare test was used for the statistic analysis.Results The benign lesions were found in 145 patients (96.0%),while the malignant tumors were found in 6 patients(4.0%).The pathological findings in the 151 HIV/AIDS patients included tuberculosis(72 patients),lymph node reactive hyperplasia(34patients),lymphatic fungal infections(23 patients,including penicillium diseases in 19 cases),AIDSrelated lymphadenectasis(14 cases),non-Hodgkin lymphoma(5 cases),benign fibrous histiocytoma (1 case).In addition,there were 83 patients(55.0%)with CD4+T lymphocyte count lower than 100×106/L.The frequency of penicillium diseases was higher in patients with lower CD4+T lymphocyte count(x2=7.757,P=0.021).Conclusions The major reasons for superficial lymphadenectasis in HIV/AIDS patients are infectious diseases,such as tuberculosis and fungal infections,which are common in patients with lower CD4+T lymphocyte counts.Non-Hodgkin lymphoma is the most common malignant tumor in this patient population.

Objective To investigate the problem of adverse effects in common AIDS patients and AIDS patients with tuberculosis after highly active antiretroviral therapy (HAART). Methods The case group was composed of 106 patients with both AIDS and tuberculosis. The control group was composed of 134 common AIDS patients. The rates of adverse effects and the increase of CD4 + T cell count in those groups after first year HAART were observed and compared. Results The rates of adverse effects in the case group was 36. 8% ,which was more than that in the control group (26. 9%), but the difference was not significantly different(x2 =2.715, P =0. 099). The count of CD4+ T cell in most of the patients was increased after HAART (P ＜ 0. 01). The increase of CD4 + T cell count in the case group [(147.2 ±137.6)/μl] was higher that in the control group[(142. 1 ± 127. 0)/μl after six months HAART vs. (166. 5±133. 1)/μl in case group], and it was lower than that in control group after nine months HAART [(172.7±107.5)/μl], however the difference was not significant(P ＞0.05). Conclusions HAARTcould reconstruct the immunition of AIDS patients. The increase of CD4 + T cell count did not show significant difference between common AIDS patients and AIDS patients with tuberculosis after HAART. AIDS patients with tuberculosis might not increase the risk of development of adverse effects during HAART.