Objective:To analyze the risk factors of internalizing problems in adolescents aged 12 to 18 years,and provide supporting evidence for the scientific prevention and effective control of internalizing problems in adolescents.Methods:By systematically searching the Chinese and English databases such as CNKI,VIP,Wan-fang,PubMed,Web of Science,Psychology and Behavioral Sciences Collection,PsycInfo,PsycArticles and ERIC,literature on risk factors of internalizing problems among adolescents in the past 22 years was collected,and non-clinical literature using CBCL or YSR or TRF scales to measure related internalizing problems were included.Meta analysis was performed using CMA3.0,with r as the effect size indicator and random effects model combined with the effect size of risk factors.Results:Finally,77 and 18 risk factors literatures were included,including 7 risk fac-tors of individuals,7 risk factors of family,and 4 risk factors of school/community.The average correlation between family risk factors and internalizing problems of adolescents was the highest.Among family risk factors,parent-child attachment had the highest correlation.Conclusion:Individual risk factors,family risk factors and school/com-munity risk factors are significantly positively correlated with adolescent internalizing problems,and family risk fac-tors(especially parent-child attachment quality)have the highest correlation with adolescent internalizing problems.

Objective To explore the application and effect of a pulmonary rehabilitation exercise program in patients with moderate to severe COPD based on the Information-Motivation-Behavior Skill(IMB)Model.Methods The convenience sampling method was adopted to select patients with moderate to severe COPD admitted to the department of respiratory and critical care medicine in a tertiary A hospital in Yantai City from October 2021 to February 2022.They were randomly divided into an intervention group(32 cases)and a control group(31 cases).The intervention group was treated with the pulmonary rehabilitation exercise program based on the IMB model on the basis of routine nursing,while the control group was treated with routine nursing.The degree of dyspnea,exercise endurance,quality of life,pulmonary rehabilitation exercise compliance,self-management ability and lung function were compared between the 2 groups before and 6 months after the intervention.Results After intervention,the degree of dyspnea,exercise endurance,quality of life,pulmonary rehabilitation exercise compliance and self-management ability were significantly different between the 2 groups(P＜0.05).There was no statistically significant difference in lung function between the 2 groups after intervention(P＞0.05).Conclusion The pulmonary rehabilitation program based on IMB model can effectively alleviate the symptoms of dyspnea in patients with moderate to severe COPD,improve exercise endurance,improve pulmonary rehabilitation exercise compliance and self-management ability,and improve the patients'quality of life.

Advance care planning (ACP) is an important part of hospice care, a core index of high-quality palliative care, and one of the effective indicators for improving the life quality of end-of-life patients. By reviewing the progress of various theoretical models and their applications in ACP, including planned behavior theory, behavioral change wheel theory, self-determination theory, prospect theory, change theory, and cultural suitability theory, this paper delved into the advantages and limitations of each theoretical model and analyzed its research prospects in future ACP clinical practice to promote researchers’ correct understanding of the role of different theoretical models in various types of studies, with a view to providing new ideas for clinical research on ACP.

A young male diagnosed with severe hemophilia A since childhood, was presented with recurrent joint and urinary bleeding. Annualized bleed rates dropped below five with low dose prophylactic medication.Bleeding in the right knee joint recently aggravated. Due to coexisting HIV infection and advanced hemophilic arthritis, the patient was managed by a multi-disciplinary team(MDT).Total knee arthroplasty was performed by an experienced surgeon using modern prosthesis design and intraoperative navigation technologies.Physical and rehabilitation therapy was provided during the postoperative period, and joint function improved. The MDT managed the young patient with HIV infection and advanced hemophilic arthritis. The patient was diagnosed with osteoporosis thought to have been caused by hemophilia, HIV infection and antiviral drugs; and he received treatment. The treatment of this patient reflects the importance of multidisciplinary cooperation in the management of difficult and rare diseases.

Objective:To investigate the pathological spectrum and variation of adult renal biopsies in People's Hospital of Xinjiang Uygur Autonomous Region from 1986 to 2020.Methods:The pathological data of 5 652 adult renal biopsies from August 1986 to December 2020 were retrospectively collected, and characteristics of pathological spectrum were analyzed. Regarding every 5 years as a research stage, the whole period was divided into 7 stages to analyze the pathological features and variation of renal biopsies. The first stage (P1) started from August 1986 to December 1990. The second stage (P2) started from January 1991 to December 1995. The third stage (P3) started from January 1996 to December 2000. The fourth stage (P4) started from January 2001 to December 2005. The fifth stage (P5) started from January 2006 to December 2010. The sixth stage (P6) started from January 2011 to December 2015. The seventh stage (P7) started from January 2016 to December 2020.Results:The age was (36.47±14.86) years old (18-83 years old) in 5 652 renal biopsies. There were 2 961 males (52.39%). There were 5 636 cases of autologous kidney biopsy and 16 cases of transplanted kidney biopsy. The descending order of incidence classified by disease types were primary glomerular disease (PGD, 4 470 cases, 79.31%), secondary glomerular disease (SGD, 994 cases, 17.64%), tubular-interstitial disease (160 cases, 2.84%), and hereditary nephropathy (12 cases, 0.21%). IgA nephropathy (IgAN, 1 573 cases, 35.19%) was the most frequent pathologic type of PGD, followed by membranous nephropathy (MN, 1 028 cases, 23.00%), mesangial proliferative glomerulonephritis (MsPGN, 878 cases, 19.64%), minimal change disease (MCD, 427 cases, 9.55%), and focal segmental glomerulosclerosis (345 cases, 7.72%). Lupus nephritis (LN, 251 cases, 25.25%) was the most common type of SGD, followed by hypertension nephropathy (193 cases, 19.42%), diabetic kidney disease (168 cases, 16.90%), purpura nephritis (138 cases, 13.88%), and ischemic nephropathy (90 cases, 9.05%). IgAN was the most common type of primary glomerulonephritis and mainly occurred in the age group of 18-59 years old. PGD was the most common glomerular disease in Han nationality (78.33%), Uygur nationality (81.72%) and other ethnic (77.15%) groups. Using Bonferroni correction method, the incidence of PGD in Uygur nationality was higher than that in Han nationality ( P<0.017). From P1 to P7, the detection rates of MN and MCD were increased in common renal pathological types, meanwhile, the ratio of MsPGN was decreased (all P<0.05). From P5 to P7, the detection rates of MN in Han nationality and Uygur nationality increased in the common pathological types of PGD, meanwhile, the ratio of MsPGN decreased (all P<0.05). LN was the most common SGD. The incidence of LN in females was higher than that in males ( P<0.001). Using Bonferroni correction method, the incidence of SGD in Uygur nationality was lower than that in Han nationality ( P<0.017). There was no significant variation in the common pathological type of SGD in Han and Uygur nationalities. Chronic rejection was the main pathological type of transplanted kidney biopsies. Conclusions:PGD is the main type of kidney disease spectrum in People's Hospital of Xinjiang Uygur Autonomous Region. IgAN is the most common PGD and mainly occurrs in the age group of 18-59 years old. As time goes by, the proportion of MN and MCD is increased, meanwhile the proportion of MsPGN is decreased significantly. LN is the most common SGD.

Objective:To explore the effects of 5E rehabilitation nursing model on self-management behavior and fatigue symptoms of patients with chronic obstructive pulmonary disease (COPD) .Methods:Totally 110 COPD patients admitted in Yantai Yuhuangding Hospital from October 2018 to September 2019 were selected by convenient sampling, and divided into the control group ( n=53) and the experimental group ( n=57) according to the random number table. Excluding missing patients and patients with incomplete data, finally 48 patients were included in the control group and 51 patients were included in the experimental group. Patients in the control group received routine care and health guidance, while patients in the experimental group received care based on the 5E rehabilitation nursing model. The Self-Management Scale for COPD Patients and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) were used to evaluate the effects of interventions in the two groups. Results:There was no statistically significant difference in the scores of the Self-Management Scale between the two groups before intervention ( P>0.05) ; the scores of all dimensions the Self-Management Scale of the experimental group were higher than those of the control group 12 weeks after discharge, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in fatigue scores between the two groups before intervention and 12 weeks after discharge ( P>0.05) . Conclusions:The 5E rehabilitation nursing model can improve the self-management behavior of COPD patients, but it cannot ameliorate the fatigue symptoms of patients. Large-sample, multi-center, and long-term research will be further needed in the future to explore the effects of the 5E rehabilitation nursing model on patients' fatigue symptoms.

Objective To explore the correlation between the methylation level of 5-hydroxytryptamine receptor 1A(HTR1A) gene promoter region and severity of symptom in the manic epi-sode patients with bipolar disorder type Ⅰ(BD-Ⅰ). Methods Fifty six manic episode patients with BD-Ⅰand fifty nine healthy controls were randomly included in the study. The level of HTR1A gene promoter meth-ylation was measured with pyrosequencing technique in both manic episode patients with BD-Ⅰ and the healthy controls. The severity of symptoms was assessed with score of Bech-Rafaelsen Mania Rating Scale (BRMS) in patients with BD-Ⅰ. Pearson correlation analysis was employed to explore the correlation be-tween the serum level of HTR1A promoter methylation and score of BRMS in BD-Ⅰgroup. Results In-creased serum level of HTR1A gene promoter methylation was found in manic episode patients with BD-Ⅰ((66. 55±10. 55)%) compared with that in healthy controls((54. 03±8. 85)%)(P<0. 01). Positive corre-lation was found between the serum level of HTR1A gene promoter methylation and total score of BRMS in manic patient with BD-Ⅰ(r=0. 534,P<0. 01). Conclusion The current findings suggest that the serum level of HTR1A gene promoter methylation can be an epigenetic indicator for severity of manic symptom in BD-Ⅰ.

Objective To establish tree shrew model of type 2 diabetes mellitus (T2DM) combined with cerebral ischemia (IS),and to explore the regulatory mechanism of ischemic postconditioning (PC) on gene differential expression in cerebral cortex under metabolic abnormalities and cerebral ischemia condition.Methods Seventy tree shrews were divided into control,T2DM,IS,T2DM+IS and T2DM +IS +PC groups (n =14 each group).The experimental diabetes model was established by the combined use of high fat diet breeding with streptozocin injection in tree shrew.The local cerebral thrombosis was induced by photochemical reaction in tree shrews,and ischemic PC was established at 4h after cerebral ischemia followed by clipped ipsilateral common carotid artery three times (5 min/time).The metabolic status of tree shrews was measured by serum biochemical markers.TTC staining,HE staining,and electron microscopy were used to observe the changes of the body's metabolic status at 24h after IS.RNA-seq was used to analyze differentially expressed genes.Results The ultrastructure of brain cells was abnormal and the cerebral infarction area was the largest in T2DM+IS tree shrews (P＜0.01).Compared with control group,body weight of tree shrews in T2DM + IS group was significantly reduced (P＜ 0.01) while blood glucose,total cholesterol,low density lipoprotein-cholesterol,triglyceride,and C-reactive protein (CRP) levels were markedly increased(all P＜0.01).The RNA-seq analysis showed that there were 1 629 differentially expressed genes (1 109 up-regulated genes and 520 down-regulated genes) in T2DM + IS group vs control group.However,ischemic PC deceased the cortical infarction area (P＜0.01)and reduced blood glucose,lipid and CRP levels (P＜0.05),with 520 differential expression genes (203 up-regulated genes and 317 down-regulated genes).Conclusion Ischemic PC improves the metabolic disturbance-aggravated ischemic brain injury in T2DM tree shrews,which may be related to its regulation on gene expression in cerebral cortex.

Objective To explore the effect of video-based education and teach-back method on health literacy and blood pressure control of elderly patients with hypertension. Methods 50 elderly hypertensive patients hospitalized in our hospital during May and December 2016 were enrolled as control group and anther 50 elderly hypertensive patients hospitalized in our hospital during January and May 2017 were assigned as the experimental group.On the basis of routine health education as in the control group,the experimental group was educated by video-based education combined with teach-back method.The health literacy and blood pressure control level of the two groups were compared before and after intervention. Result After intervention,the level of health literacy of the experimental group was significantly better than that of the control group,and the level of blood pressure control was significantly better than that of the control group as well (P<0.001 and P<0.05). Conclusions Video-based education combined with teach-backmethod is an effective way for health education.It has good effect on improving health literacy and blood pressure control level of elderly patients with hypertension.

Objective To explore the association between cardiorespiratory fitness and physical activities in physically active patients with type 2 diabetes mellitus. Methods From July to November, 2017, 41 physically active patients with type 2 diabetes mellitus were measured physical activities with International Physical Activity Questionnaire, and cardiorespiratory fitness with cardiopulmonary exercise testing (CPET) by bicycle ergometer. The association between cardiorespiratory fitness and physical activity was analyzed with bivariate correlation analysis and Logistic regression. Results Leisure-time physical activities positively correlated with peak oxygen consumption and oxygen consumption at anaerobic threshold (r = 0.393-0.503, P < 0.05), while leisure-time physical activities independently and positively correlated with normal cardiorespiratory fitness (OR = 5.661, P = 0.017). Conclusion Leisure-time physical activities can improve the cardiorespiratory fitness in physically active patients with type 2 diabetes mellitus, which should be encouraged rather than other activities.