Xiang thinking is a cognitive approach that reflects the relationships between phenomena and their underlying principles by analyzing their external manifestations through methods such as analogy， reasoning， deduction， and symbolism. This article applied xiang thinking to analyze the etiology and pathogenesis of "wind， fire， phlegm， and blood stasis" in stroke， thereby exploring its impact on the principles of syndrome differentiation and treatment of this condition. Meanwhile， the article traced the construction process of xiang thinking， and interpreted the concept of "toxin pathogen" in traditional Chinese medicine from four perspectives， state， attribute， origin， and law. Furthermore， the relationship between the process of constructing xiang thinking and the origin of etiology， identification methods， pathogenesis evolution， and treatment strategies for stroke with syndrome of combined blood stasis and toxin was explored， so as to provide insights into research on the etiology and pathogenesis of stroke， as well as clinical diagnosis and treatment approaches.

Xiang thinking is the key way of thinking to construct the life model of human body in traditional Chinese medicine （TCM）， and the theory of ascending and descending of qi movement is an important manifestation of xiang thinking in the theory of TCM. Based on the theory of qi movement， this paper interpreted the mechanism of ischemic stroke through the perspective of xiang thinking "earth weakness - wood constraint - fire hyperactivity"， as "earth weakness in the central and dampness accumulated to phlegm" "wood constraint and stirring wind led to blood stasis" and "fire hyperactivity and fire toxin showed flaming upward" due to disorder of qi movement. Combined with the "xiang of medicinal properties and therapy methods" to discuss the treatment and prescriptions of ischaemic stroke， applying wind medicinals to elevate ji-earth （己土） and yi-wood （乙木）， so that phlegm and stasis can be eliminated， and cold medicinals to descend jia-wood （甲木） and wu-earth （戊土） so that fire toxin can be cleared， with a view to restore ascending and descending of qi movement for ischaemic stroke.

Background and purpose:Transmembrane and coiled-coil domains 1(TMCO1)is a recently discovered endoplasmic reticulum calcium channel protein that has been found to be associated with the progression of various tumors,however,its role in cervical cancer has not yet been clarified.This study aimed to investigate the effects of TMCO1 on the proliferation and migration of cervical cancer HeLa cells.Methods:By transfecting cervical cancer HeLa cells with plasmids,cells with stable overexpression of TMCO1 and cells with stable knockdown of TMCO1 were obtained.Cell counting kit-8(CCK-8)assay,clone formation assay and EdU labeling assay were used to detect cell proliferation ability,transwell assay was used to detect cell migration ability,and proteomic analysis was performed on the cells that stably overexpressed TMCO1 and control cells.Results:TThe CCK-8 experiment and clone formation experiment showed that overexpression of TMCO1 in cervical cancer HeLa cells significantly increased their proliferation ability(P＜0.05).EdU labeling experiments showed that overexpression of TMCO1 in cervical cancer HeLa cells significantly increased the number of cells undergoing active DNA synthesis(P＜0.01).After knocking down TMCO1 in cervical cancer HeLa cells,the expression of cell cycle inhibitory protein p27 increased,and the phosphorylation of histone H3 decreased.Clonogenesis experiments showed that knocking down TMCO1 significantly inhibited the proliferation of cervical cancer HeLa cells(P＜0.001).EdU labeling experiments showed that after knocking down TMCO1 in cervical cancer HeLa cells,the number of cells undergoing active DNA synthesis was significantly reduced(P<0.05).Transwell experiment showed that overexpression of TMCO1 in cervical cancer HeLa cells significantly increased their migration ability(P＜0.001),while knocking down TMCO1 significantly inhibited the migration of cervical cancer HeLa cells(P＜0.001).The pathways related to extracellular matrix adhesion and PI3K-AKT signaling were significantly upregulated in the cells with stable overexpression of TMCO1,while ribosome related pathways were downregulated in proteomic analysis.Conclusion:Overexpression of TMCO1 significantly promotes the proliferation and migration of cervical cancer cells,while knockdown of TMCO1 significantly inhibits the proliferation and migration of cervical cancer HeLa cells.TMCO1 may affect the proliferation and migration of HeLa cells by regulating cell adhesion and signal transduction.

ObjectiveTo investigate the comprehensive spoken communication performance of children with disabilities, and explore the related individual and environmental factors. MethodsFrom August to November, 2022, questionnaires of Communication Function Scale for Children based on ICF-CY were distributed online to parents of healthy children and children with disabilities aged two years to five years and eleven months in Shanghai, Nanjing and other areas. ResultsA total of 500 copies were sent out, and 407 valid questionnaires were returned, including 84 healthy children, 85 with hearing impairment, 119 with mental retardation, 35 with cerebral palsy and 84 with autism. There were significant differences in the comprehensive spoken communication function performance among the children with different impairment types (F = 127.618, P < 0.001). The comprehensive spoken communication ability was significantly poorer in the children with disabilities than in the healthy children (P < 0.05), and the ability was better in hearing-impaired children than in the children with other disabilities (P < 0.05). The higher the education of mother (r = -0.311, P < 0.001) and father (r = -0.280, P < 0.001), and family annual income (r = -0.228, P < 0.001), the better the children's comprehensive spoken communication performance; the children's comprehensive spoken communication performance was better when the family used Putonghua as unified communication language (r = 0.210, P < 0.001). ConclusionThe comprehensive spoken communication performance for children with disabilities is heterogeneous among different impairment types, and is affected by parents' education, family annual income, and family communication language.

Objective To investigate the risk factors of cognitive dysfunction in patients with traumatic brain injury. Methods From March to September, 2021, 556 hospitalized patients with traumatic brain injury were selected from a multicenter study. A 1∶1 sex-matched case-control study design was used. After assessment by Montreal Cognitive Assessment (MoCA), those with cognitive impairment were as case group and those without cognitive impairment were as control group. They were collected general data and assessed with Social Support Rating Scale (SSRS) and Hospital Anxiety and Depression Scale (HADS). Results Logistic regression analysis showed that college education or above (OR = 0.040) and high level of social support (OR = 0.118) were protective factors for cognitive impairment (P < 0.05). Aged 60 to 88 years (OR = 9.996), severe brain injury (OR = 7.345), headache after injury (OR = 2.159), frequent waking at night or multiple dreams ≥ three times per week (OR = 3.705), severe upper limb dysfunction caused by brain injury (OR = 6.072), depression (OR = 5.202) were risk factors for cognitive impairment (P < 0.05). Conclusion The related factors for cognitive impairment in patients with traumatic brain injury include general factors, disease factors, sleep, psychological and social support and other factors. It is suggested that in addition to the treatment of disease, it is necessary to improve sleep, psychology and social support, to reduce the incidence of cognitive impairment and promote the recovery of disease.

ObjectiveTo analyze the typical performance of initiating and responding behaviors of turn-taking in operational games for autistic children with low language function in special education schools and to provide a reference for intervention of turn-taking behaviors in operational games. MethodsFrom November, 2021 to January, 2022, a total of 23 autistic children with low language function (language ability ≤ three years old) in Shanghai Putuo District Qixing School were selected. Their linguistic ability was evaluated. A behavioral assessment approach was used to evaluate the behavior of initiating and responding behaviors of turn-taking in three operational games. The typical errors in initiating behaviors were summarized as difficult to initiate, untimely initiation, no response and abnormal initiation. The typical errors in responding behaviors of turn-taking in operational games were summarized as difficult to respond, untimely response, no response and abnormal response. ResultsThere was no significant differences in the performance of initiating behaviors among three types of operational games (χ² = 11.106, P = 0.196), and there were significant differences in the performance of responding behaviors among operational games (χ² = 26.256, P = 0.001). The initiating behaviors were postively correlated with word comprehension (r = 0.420, P < 0.05), word naming (r = 0.510, P < 0.05), and sentence imitation (r = 0.505, P < 0.05). The responding behaviors were postively correlated with word comprehension (r = 0.546, P < 0.01), word naming (r = 0.728, P < 0.01), sentence comprehension (r = 0.668, P < 0.01) and sentence imitation (r = 0.656, P < 0.01). ConclusionAutistic children with low language function showed different typical behaviors of initiating and responding behaviors of turn-taking in operational games. It is suggested that when designing training programs for turn-taking skills, targeted interventions should be made to address the typical types of errors in response and initiation turns, and individualized intervention programs should be designed to enhance children's communicative efficacy in play game and promote their language development and social participation.

Objective:To translate the English version of the Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) into Chinese, and test the reliability and validity of the Chinese version of the scale.Methods:The Brislin translation model was adopted to translate the scale forward and back to form the Chinese version of SRLS-CNP. The Chinese version of SRLS-CNP was culturally adjusted through cognitive interviews, expert consultations and pre-surveys. From December 2020 to April 2021, convenience sampling was used to select 1 452 nursing undergraduates from 4 undergraduate medical schools in Anhui Province as the research object. The Chinese version of SRLS-CNP was used for investigation to test the reliability and validity of the scale.Results:The Chinese version of SRLS-CNP included 2 subscales of motivation and learning strategies, with a total of 16 items. The motivation subscale extracted 2 common factors, and the cumulative variance contribution rate was 74.709%. The learning strategy subscale extracted 3 common factors, and the cumulative variance contribution rate was 76.364%. The Cronbach's α coefficient of the total scale was 0.940. The Cronbach's α coefficient of the motivation subscale was 0.875, and the Cronbach's α coefficient of each dimension was from 0.850 to 0.867. The Cronbach's α coefficient of the learning strategies subscale was 0.919, and the Cronbach's α coefficient of each dimension was from 0.807 to 0.886. The half-reliability coefficient of the total scale was 0.882, and the half-reliability coefficients of the motivation and learning strategies subscale were 0.698 and 0.871, respectively. The test-retest reliability coefficient of the total scale was 0.936, and the test-retest reliability coefficients of the motivation and learning strategies subscale were 0.857 and 0.832, respectively.Conclusions:The Chinese version of SRLS-CNP has good reliability and validity, and can be used to evaluate the self-regulated learning ability of clinical nursing practice of undergraduate nursing students in China.

Osteomalacia is a metabolic bone disease characterized by impaired mineralization of bone matrix. VitaminD deficiency contributes to a decrease in the efficiency of intestinal calcium and phosphorus absorption, resulting in secondary hyperparathyroidism and an inadequate calcium-phosphorus product, thereby causing osteomalacia. We present a patient who was diagnosed as vitamin D-deficient osteomalacia due to X-linked agammaglobulinemia ( XLA) , and the genetic analysis of the BTK gene revealed a missense mutation ( c.82C>T) . It should be attached great importance to etiological analysis of osteomalacia, and XLA may also be a cause of vitamin D deficiency.

Objective To establish a rapid and sensitive liquid chromatograph-mass spectrometry (LC-MS/MS) method for the determination of thiabendazole in honeysuckle flowers. Methods The acetic ether was selected as extraction solvent. The mass spectrometer analysis was conducted in the positive ionization electrospray mode using SIM. The transitions m/z 202→175 was used to quantify thiabendazole. Results The satisfactory linearity was obtained in the range of 0.1×10-5-2×10-5mg for thiabendazole (r=0.999 5), and the limit of detection (LOD) of 10.0 ng/ml and the mean recovery of 93.70% were obtained by this LC-MS/MS method. Conclusions The method of LC-MS/MS is sensitive, simple and accurate, and it proved to be suitable for the determination of thiabendazole in Honeysuckle flowers.

OBJECTIVE To evaluate the clinical value of contrast-enhanced ultrasonography (CEUS) in diagnosing thyroid carcinoma.METHODS The clinical data of 129 patients with thyroid nodules,who were examined by CEUS and were operated in Xinhua Hospital between Jan 2014 and Aug 2015,were analyzed in order to compare the diagnostic results of CEUS to the postoperative pathologic findings,and to summarize its imaging features.RESULTS A total of 132 thyroid nodules in 129 patients were examined by CEUS.Among them,103 nodules were diagnosed as thyroid carcinoma,24 nodules were benign thyroid tumor and 5 nodules were thyroiditis.Compared with pathology results,the diagnostic accuracy,sensitivity and specificity of contrast-enhanced ultrasound is 88.6％,92.2％ and of 75.9％ respectively.The diagnosis of the CEUS in 31 cases was not consistent with the pathological results,in which 8 cases of thyroid carcinoma were misdiagnosed as benign tumor,3 cases of thyroiditis were misdiagnosed as thyroid carcinoma,and 20 cases of benign tumors were misdiagnosed as thyroid carcinoma.The malignant thyroid nodules mainly were papillary carcinoma,which was characterized by'low enhanced'and'slow in fast out'performance in the contrast-enhanced ultrasound examination.CONCLUSION The contrast-enhanced ultrasound examination in diagnosing thyroid carcinoma has much more specificity and sensitivity,the'low-enhanced'and'slow in fast out'signs of the CEUS were the important features of malignant thyroid nodules.