ObjectiveTo investigate the effects of Jiaohong pills （JHP） and its prescription， Pericarpium Zanthoxyli （PZ） and Rehmanniae Radix （RR） cognitive dysfunction in scopolamine-induced Alzheimer's disease （AD） mice and its mechanism through pharmacodynamic and metabolomics study. MethodThe animal model of AD induced by scopolamine was established and treated with PZ， RG and JHP， respectively. The effects of JHP and its formulations were investigated by open field test， water maze test， object recognition test， avoidance test， cholinergic system and oxidative stress related biochemical test. Untargeted metabolomics analysis of cerebral cortex was performed by ultra-performance liquid chromatography-Quadrupole/Orbitrap high resolution mass spectrometry （UPLC Q-Exactive Orbitrap MS）. ResultThe behavioral data showed that， compared with the model group， the discrimination indexes of the high dose of JHP， PZ and RR groups was significantly increased （P<0.05）. The staging rate of Morris water maze test in the PZ， RR， high and low dose groups of JHP was significantly increased （P<0.05， P<0.01）， the crossing numbers in the PZ， JHP high and low dose groups were significantly increased （P<0.05， P<0.01）； the number of errors in the avoidance test were significantly reduced in the PZ and high-dose JHP groups （P<0.01）， and the error latencies were significantly increased in the JHP and its prescription drug groups （P<0.01）. Compared with the model group， the activities of acetylcholinesterase in the cerebral cortex of the two doses of JHP group and the PZ group were significantly increased （P<0.05， P<0.01）， and the activity of acetylcholinesterase in the high-dose JHP group was significantly decreased （P<0.05）， and the level of acetylcholine was significantly increased （P<0.01）. At the same time， the contents of malondialdehyde in the serum of the two dose groups of JHP decreased significantly （P<0.05， P<0.01）. The results of metabolomics study of cerebral cortex showed that 149 differential metabolites were identified between the JHP group and the model group， which were involved in neurotransmitter metabolism， energy metabolism， oxidative stress and amino acid metabolism. ConclusionJHP and its prescription can antagonize scopolamine-induced cognitive dysfunction， regulate cholinergic system， and reduce oxidative stress damage. The mechanism of its therapeutic effect on AD is related to the regulation of neurotransmitter， energy， amino acid metabolism， and improvement of oxidative stress.

ObjectiveTo study the plasma pharmacokinetics and tissue distribution of five representative components in Wujiwan， and to illustrate the difference of metabolism and tissue distribution before and after compatibility. MethodHealthy male SD rats were divided into four groups， including Wujiwan group（A group， 62.96 g·L^-1）， Coptidis Rhizoma group（B group， 38.4 g·L^-1）， processed Euodiae Fructus group（C group， 5.88 g·L^-1） and fried Paeoniae Radix Alba group（D group， 18.68 g·L^-1）， with 65 rats in each group， and were administered the drugs according to the clinical dose of decoction pieces converted into the dose of the extracts. Then plasma， liver， small intestine and brain were taken at pharmacokinetic set time in each group after administration. Ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry was developed for the quantitative analysis of five representative components［berberine（Ber）， palmatine（Pal）， evodiamine（Evo）， rutecarpine（Rut） and paeoniflorin（Pae）］ in Wujiwan， their concentrations in plasma， liver， small intestine and brain were detected at different time， plasma samples were processed by protein precipitation， and tissue samples were pretreated by protein precipitation plus liquid-liquid extraction. Non-atrioventricular model was used to calculate the pharmacokinetic parameters of each component， and the parameters of each group were compared. ResultPharmacokinetic results of A group showed that area under the curve（AUC_0-t） of the five representative components were ranked as follows：Ber and Pal were small intestine>liver>blood， Evo and Rut were liver>small intestine>plasma， Pae was small intestine>plasma， which was not detected in the liver， no other components were detected in brain except for Ber. In comparison with plasma and other tissues， peak concentration（C_max） of Ber， Pal， Evo， and Rut were the highest and time to peak（t_max） were the lowest in the liver of A group. In plasma， the AUC_0-t and C_max of Evo and Rut were increased in A group compared with C group， t_max of Pea was elevated and its C_max was decreased in A group compared with D group. In the liver， compared with B-D groups， C_max values of 5 representative components except Pae were elevated， AUC_0-t of Pae was decreased and AUC_0-t of Evo and Rut were increased in the A group. In the small intestine， half-life（t_1/2） of each representative components in A group was elevated and t_max was decreased， and C_max of each representative ingredient except Pal was decreased， AUC_0-t values of Ber and Pal were increased， whereas the AUC_0-t values of Evo and Rut were decreased. ConclusionThe small intestine， as the effector organ， is the most distributed， followed by the liver. The pharmacokinetic parameters of the representative components in Wujiwan are changed before and after compatibility， which is more favorable to the exertion of its pharmacodynamic effects.

Dementia in traditional Chinese medicine （TCM） mainly presents amnesia and dullness. Alzheimer's disease and vascular dementia belong to the category of dementia in TCM. These progressive neurological diseases have a complex etiology and a long course， and the drugs that can reverse the disease course remain to be developed. Therefore， early intervention plays a vital role in delaying the disease progression. Apathy refers to a lack of motivation that leads to the attenuation or disappearance of goal-directed behaviors， cognitive functions， and emotional responses. Clinical studies have suggested that apathy exists in the early stage of a variety of neurodegenerative diseases， being one of the key symptoms to the early diagnosis of dementia. The severity of apathy is related to the severity of dementia. Therefore， early diagnosis and treatment of apathy are of great significance to the prevention and treatment of dementia. The preclinical research on apathy in dementia is still in its infancy， and the systematic evaluation method has not been prescribed. The clinical diagnosis and treatment are also in the exploratory stage， and the complex pathophysiological mechanisms of apathy and dementia development have not been fully elucidated. This article reviews the research progress of apathy in dementia， the apathetic behaviors of dementia animal models， the behaviors of patients with apathy， and the treatment methods in recent years and summarizes the research status of apathy in dementia. This review aims to provide a theoretical basis for exploring the behavior of apathy in dementia and conducting preclinical research and evaluation of the pathogenesis and to lay a foundation for the treatment of apathy in dementia.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To compare the predicted efficiency ofmacular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery.Methods This is a prospective exploratory clinical study.A total of 63 patients (63 eyes) with idiopathic MH,who received vitrectomy,inner limiting membrane peeling and gas tamponade,were enrolled in this study.All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=(M+N) /BASE,M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole,respectively.BASE is the length of MH base.MHCI1 was measured by built-in caliper of OCT software,MHCI2 was measured by ImageJ software.The minimum macular diameter (MHD) was measured by built-in caliper of OCT software.Based on the OCT images,the anatomical outcomes were classified grade A (bridge-like shape closure),grade B (complete closure) and grade C (poor closure).Grade A and B are considered as good closure,grade C as poor closure.Patients were followed up at 3,6 and 12 months after surgery.The closure grades at last visit were the final outcome.The relationship between MHCI 1,MHCI2 and closure grades was analyzed.And the predicted efficiency of MHD,MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied.Results The mean MHCI1 was 0.68±0.21 (0.30-1.35),MHCI2 was 0.95±0.26 (0.41-1.55),and MHD was (476.24±210.18) μm (127-956 μm).MHCI1 and MHCI2 were both negative correlated with the closure grades (r=-0.665,-0.691;P＜0.001).The receiver operating characteristic (ROC) curve analysis ofMHCI1,MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928,0.957 and 0.916 respectively,and 0.505,0.67 and 559 μm were set as the lower cut-offvalue.The sensitivity was 96.2％,92.3％ and 90.9％ respectively,and specificity was 81.8％,72.7％ and 76.9％ respectively.Accordingly,the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840,0.847 and 0.653 respectively,and 0.705,0.965 and 364 μm were set as the upper cut-off value.The sensitivity was 80.0％,82.9％,63.4％ respectively and specificity was 75.0％,85.7％,65.9％.Conclusion MHCI1 and MHCI2,measured by built-in caliper of OCT software or ImageJ software,both have good predictive efficiency for the anatomical outcomes of MH surgery.

Objective:To explore the effect of occupational protection compensation education carried out in nursing students practice in department of orthopedic on the occupational protection knowledge level and occupational injuries. Methods:From 2013 to 2014, nursing students practice in department of orthopedics did not receives occupational protection compensation education, from 2014 to 2015, nursing students received occupational protection compensation education before practice. Questionnaire investigation of nursing students at the end of practice was done. Results:Compared with nursing students practice in department of orthopedic from 2013 to 2014,occupational protection knowledge score was higher and the number of occupational injuries occurred during internship people was significantly lower in nursing students practice in department of orthopedic from 2014 to 2015 (P<0.05 and 0.01) . Conclusion:To strengthen the occupational protection compensation education in nursing students, can improve knowledge of occupational safety and protective ability,reduce occurred rate of the occupational injuries.

Objective To investigate the actuality of self-compassion and perceived social support among probationer nursing students, and to analyze the relationship between them. Methods 552 probationer nursing students from three tertiary hospitals in Suzhou were investigated by means of the Self-Compassion Scale (SCS) and Perceived Social Support Scale (PSSS). Results The probationer nursing students′ self-compassion and perceived social support was (3.20 ± 0.61) points and (5.81 ± 1.13) points, respectively. Scores of the total scale and the factors of self-compassion and perceived social support were positively correlated (r=0.485, P<0.01). Hierarchical regression analysis showed that perceived social support (family support and friend support) could be used to forecast the self-compassion of probationer nursing students and independently explain the variation of their self-compassion of 21.5%(△R2=0.215, P<0.01). Conclusions Self-compassion among probationer nursing students is in medium level, and perceived social support an important factor affecting their self-compassion.

Objective:To analyze the system of first contact in community health institutions for migrant workers in Shenzhen city with the stakeholder theory. Methods:The report forms of the Social Insurance Fund Administration Bureau and the health bureau of Shenzhen city were used to analyze. All stakeholders of this policy were interviewed. Results:The system of first contact in community health institutions was good for all stakeholders. The number of in-sured migrant workers grew steadily, the business volume of community health service centers increased significantly, and the fund ran smoothly. Conclusions:The effects of the system of first contact in community health institutions for migrant workers in Shenzhen city were obvious. All the stakeholders felt satisfied with the policy.

The system of first contact in community health institutions, as the core element of hierarchical di-agnosis and treatment system, is of great importance for reforming successfully China’ health service system. The sys-tem of first contact in community health institutions implemented among labor workers in Shenzhen City plays an im-portant role in patients ’ distribution and the interested parties can accept this mandatory system. Campared with Shenzhen City, the level of services is enough to meet patients’ primary health demands in some cities which the com-munity health service develops well, and it should be thought highly of the mandatory in the process of policy imple-mentation in order to ensure the implementation effect.

Objective:To explore the utilization of and satisfaction at community health service between migrant and non-migrant workers in Shenzhen city. Methods: Random sampling was used and 8000 community residents in Shenzhen city were investigated, and the data was analyzed with SPSS 18. 0. Results:There was statistically signifi-cant difference on the times of seeking community health services last year between migrant workers and non-migrant workers ( P<0. 0001 ) , and the proportion of more than three times service utilization of migrant workers were greater than that of non-migrant workers. The top three elements inpluencing satisfaction at community health service between migrant and non-migrant workers were service attitude ( 73. 29% vs. 73. 46%) , technical level ( 65. 29% vs. 67. 50%), and its convenience of seeking a doctor (63. 16% vs. 64. 98%). 73. 47% of users (migrant workers:74. 16%, non-migrant workers:69. 71%) were willing to accept the system of first contact in community health in-stitutions. Conclusions:The utilization of community health service has increased since implementing the system of first contact in community health institutions. Both migrant workers and non-migrant workers were very satisfied with the community health services, and the differences on satisfaction between the two groups were not significant. It is feasible to gradually promote the system of first contact in community health institutions over China.