Objective:To explore the anxiety level, influencing factors among surrogate decision-makers of patients with acute ischemic stroke during thrombolysis decision-making, and their correlation with decision-making duration.Methods:Acute ischemic stroke patients and their surrogate decision-makers who visited the Emergency Department of the First Affiliated Hospital of Zhengzhou University from September 2019 to December 2021 were selected as the research subjects.Sociodemographic data and disease related data of patients and surrogate decision-makers were collected.Surrogate decision-makers were evaluated with the state-trait anxiety inventory, decision participation expectation scale, Wake Forest physician trust scale, and perceived social support scale.SPSS 26.0 software was used for data processing.Pearson correlation analysis, Spearman correlation analysis and ridge regression analysis were used for statistical analysis.Results:The score of state anxiety of decision-makers was (49.47±9.04), and 18.2% (70/383) of decision-makers had a decision duration exceeding 15 minutes.The score of state anxiety of decision-makers was positively correlated with decision duration ( r=0.189, P<0.001). The influencing factors of state anxiety level of decision-makers included sociodemographic factors (age of decision-makers and patients, relationship between payers and patients, whether decision-makers bear the current medical expenses, type of medical insurance for patients), psychological factors (trust level in physicians, perceived social support), factors related to patient disease (numbers of stroke relapses, National Institutes of Health stroke scale scores for patients), characteristics of the decision-making process (whether patients participate in the decision-making process, and the role of decision-makers in the decision-making process) (all P<0.05). Conclusion:Most surrogate decision-makers experience anxiety.Medical staff should pay attention to the emotions of decision-makers and adopt appropriate communication skills when communicating with informed consent for thrombolysis, alleviate the anxiety of surrogate decision-makers, so as so reduce the decision-making duration.

Objective:To investigate the effects of Shenghui Yizhi Decoction on learning and memory ability of SAMP8 mice; To explore its mechanism.Methods:Totally 24 male SAMP8 mice were randomly divided into model group, donepezil hydrochloride group (1 mg/kg) and Shenghui Yizhi Decoction group (15.6 g/kg), with 8 mice in each group, and eight anti rapid aging mice (SAMR1) of the same age and strain were set as the control group. The mice in each group were given corresponding medication or the same volume of distilled water for 90 days. After administration, Morris water maze was used to detect the learning and memory ability and space exploration ability of mice. Immunohistochemistry was used to detect expression of β Amyloid protein 1-42 (Aβ 1-42) in hippocampal. ELISA was used to detect the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Real time PCR was used to detect expressions of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), cysteine protease-1 (Caspase-1), and IL-1β mRNA. Western Blot was used to detect expression of NLRP3, Caspase-1and IL-1β protein. Results:Compared with model group, the spatial exploration ability and memory ability of mice in Shenghui Yizhi Decoction group and donepezil hydrochloride group were improved ( P<0.05, P<0.01), the expression of Aβ 1-42 in hippocampus decreased ( P<0.05, P<0.01), the contents of IL-1β, IL-6 and TNF-α decreased ( P<0.05, P<0.01), and the mRNA and protein expressions of NLRP3, Caspase-1 and IL-1β decreased ( P<0.05, P<0.01). Conclusion:Shenghui Yizhi Decoction can effectively improve the learning and memory ability of SAMP8 mice, and its mechanism may be related to inhibiting the activation of inflammasome and neuroinflammatory response by regulating the NLRP3/ Caspase-1/ IL-1β signaling pathway.

Objective: To investigate the effects of health management based on the theory of protection motivation on fatigue status, neurological function recovery and life ability of stroke patients, and evaluate its clinical effects. Methods: A total of 120 stroke patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were selected as subjects. Randomized digital table method was used to divided them into observation group and control group, 60 cases in each group; the control group underwent routine nursing and follow-up of neurology, and the observation group was given health management based on protection motivation theory on the basis of the control group. The Fatigue Severity Scale (FSS) was used to assess the patient's fatigue, the European Stroke Scale (ESS) was used to evaluate the patient's neurological function, the modified Barthel index was used to assess the patient's viability. The fatigue, neurological recovery, and changes in living ability were compared between the two groups before and after the nursing intervention. Results: The Scores of FSS, MBI and ESS of the observation group were 45.34±8.84, 54.3±4.69 and 45.24±4.18 before intervention and 32.48±5.80, 75.50±4.93, 63.12±3.32 after intervention. The Scores of FSS, MBI and ESS of the control group was 44.97±8.47, 53.47±4.20, 43.48±5.67 before intervention and 39.59±7.43, 63.81±3.25, 55.32±3.48 after intervention. The difference after intervention between the two groups was statistically significant (t values were 15.335, 12.562, 5.843, P<0.01). The difference in the observation group before and after intervention was statistically significant (t values were 9.422, 24.133, 25.945, P<0.01). The differences in the control group before and after intervention was statistically significant (t values were 3.699, 15.082, 13.786, P<0.01). Conclusions Health management based on the theory of protection motivation is more effective than routine nursing to improve the fatigue, neurological function and life ability of stroke patients.

Objective:To explore adversity quotient level of nursing postgraduates and analyze the influencing factors.Methods:Using the convenient sampling method, nursing postgraduates from 9 schools in China from April to May 2020 were selected as research objects. The general information questionnaire, Adversity Response Profile (ARP) , General Self-efficacy Scale (GSES) and Simplified Coping Style Questionnaire (SCSQ) were used to investigate.Results:The total score of ARPof 234 nursing postgraduates was (127.77±13.616) . The results of multi-factor analysis showed that family annual income, self-efficacy and positive coping styles were the influencing factors of adversity quotient for nursing postgraduates.Conclusions:The adversity quotient of nursing postgraduates in China is at a medium level. Graduate students with medium or high annual household income, high self-efficacy and positive coping styles have a higher adversity quotient.

Objective To search and summarize the best evidence about the management of dysphagia in stroke domestic and abroad. Methods Computer retrieval of American guide network, BMJ best clinical practice, Scottish inter college guide network, Canadian clinical practice guide database, JBI evidence-based health care center of Australia, Ontario Registered Nurses Association of Canada, medical pulse guide network, PubMed, Ovid, EMBASE, web of science, CNKI and Wanfang database, etc, with the retrieval time limit from January 2010 to June 2019. Search for guidelines and systematic reviews related to dysphagia after stroke, evaluate and summarize the best evidence. Results A total of 11 clinical practice guidelines and 39 systematic evaluations were selected. After evidence extraction and summary, 6 categories and 32 best evidences related to dysphagia disorders of stroke were extracted, including screening, evaluation, treatment, complication prevention (oral care and nutrition risk screening), health education and training. Conclusions In order to ensure the quality of medical care and the safety of patients, medical staff should use the evidence related to dysphagia disorders of stroke according to the relevant level of evidence-based medical evidence.

Objective To explore the effect of intermittence oro-esophageal tube feeding on the comfort and swallowing function of paralytic patients with swallowing disorder.Methods A total of 80 paralytic patients with dysphagia who were hospitalized in Neurology Department of the First Affiliated Hospital of Zhengzhou University from January to December 2016 and met the inclusion criteria were selected by convenience sampling method and divided into observation group and control group according to random number table, with 40 cases in each group. Intermittence oro-esophageal tube feeding was used in observation group, and nasogastric feeding was used in control group. The nasopharyngeal comfort of both groups on the third and tenth day of intervention and patients' swallowing function before feeding and on the tenth day of intervention were compared respectively.Results On the third and tenth day of intervention, the differences between the two groups on the symptoms of nasal discomfort, throat pain, oropharyngeal dryness and swallowing discomfort were statistically significant (P<0.01). There was no statistical difference in the extent of swallowing disorder between the two groups before intervention (P>0.05). Comparing the two groups on the tenth day of intervention, the difference of patients' swallowing function was statistically significant (P<0.01). Patients' swallowing function recovery on the tenth day of intervention was statistically different between the two groups (P<0.01). Conclusions Intermittence oro-esophageal tube feeding can significantly improve the comfort and the swallowing function in stroke patients. Thus, intermittence oro-esophageal tube feeding is a worthy method to expand in clinical practice.

Objective?To analyze the mediating effects of the sense of coherence between mental stress and depression in stroke patients, and to offer guidance and assistance to reducing mental stress and depression and improving mental health in stroke patients. Methods?Totally 468 stroke patients were selected from the Department of Neurology of a ClassⅢ Grade A hospital in Zhengzhou by convenient sampling between July 2016 and July 2017 and investigated with Sense of Coherence Scale (SOC-13), Chinese Perceived Stress Scale (CPSS) and Center for Epidemiologic Studies Depression Scale (CES-D). The data were statistically analyzed with SPSS 21.0 and AMOS 22.0. Results?The total average scores for SOC-13, CPSS and CES-D in these stroke patients were (63.39±9.92), (41.65±7.29) and (23.80±4.20), respectively. The sense of coherence was negatively correlated with mental stress and depression (r=-0.47,-0.51;P＜0.01), and mental stress was positively correlated with depression (r=0.52,P＜0.01). As a meditating variable, the sense of coherence reduced the adverse prediction effects of mental stress on depression from 0.632 to 0.283. According to the re-analysis of the structural equation model, the sense of coherence was the mediating variable between mental stress and depression. The fit indexes were good (χ2/df=2.450, GFI=0.942,AGFI=0.941, CFI=0.940, TLI=0.922, RMSEA=0.052, RMR=0.036). Conclusions?As the mediating effect between mental stress and depression, the sense of coherence reduces the adverse prediction effects of mental stress on depression to some extent. Therefore, the sense of coherence in stroke patients shall be enhanced to improve their mental health and reduce the incidence of depression.

Objective To investigate the efficacy and safety of low-dose rituximab therapy and sequential maintenance for patients with refractory idiopathic thrombocytopenic purpura. Methods Thirty-three patients with refractory idiopathic thrombocytopenic purpura received intravenous rituximab at the dose of 100 mg once a week for 4 consecutive weeks. Complete blood cell count and serum concentrations of immunoglobulin (IgG,IgM and IgA) were monitored regularly. The numbers of CD3+ and CD19+ CD20+ lymphocyte cells were assayed by flow cytometry before and after therapy. Twenty-five patients with responses(complete response and response) were divided into maintained group (12 patients) and control group (13 patients) by random digits table method. The patients in maintained group were treated with rituximab 100 mg every 6 months. The efficacy of maintenance therapy was evaluated through long-term follow-up. Results The complete response(CR) rate, response (R) rate and no response(NR) rate were 48.48%(16/33), 27.27%(9/33) and 24.24% (8/33), respectively. As a result, total effective rate was 75.76% (25/33). There were no significant changes of peripheral blood white blood cell count,hemoglobin,serum immunoglobulin and CD3+lymphocyte counts before and after treatment (P>0.05). However, CD19+ CD20+ cells were almost depleted in patients treated with rituximab: (3.71±2.64)×106/L vs. (279.33±92.78)×106/L, P<0.01. Five patients suffered from allergic response, and 1 patient developed pneumonia and respiratory failure. The relapse rates of maintained group and control group were 1/12 and 4/13, respectively. Conclusions Treatment with low-dose rituximab may be an effective and safe approach in patients with idiopathic thrombocytopenic purpura. Relapse rates can be decreased through maintenance therapy with refractory low-dose rituximab. However, the optimal therapeutic schedule need further investigation.

BACKGROUNDHypocretin (HCRT) signaling plays an important role in the pathogenesis of narcolepsy and can be significantly influenced by Chinese herbal therapy. Our previous study showed that xingshentongqiao decoction (XSTQ) is clinically effective for the treatment of narcolepsy. To determine whether XSTQ improves narcolepsy by modulating HCRT signaling, we investigated its effects on SH-SY5Y cell proliferation, apoptosis, and HCRT receptor 1/2 (orexin receptor 1 [OX1R] and orexin receptor 2 [OX2R]) expression. The signaling pathways involved in these processes were also assessed.

METHODSThe effects of XSTQ on proliferation and apoptosis in SH-SY5Y cells were assessed using cell counting kit-8 and annexin V-fluorescein isothiocyanate assays. OX1R and OX2R expression was assessed by quantitative real-time polymerase chain reaction analysis. Western blotting for mitogen-activated protein kinase (MAPK) pathway activation was performed to further assess the signaling mechanism of XSTQ.

RESULTSXSTQ reduced the proliferation and induced apoptosis of SH-SY5Y cells. This effect was accompanied by the upregulation of OX1R and OX2R expression and the reduced phosphorylation of extracellular signal-regulated kinase (Erk) 1/2, p38 MAPK and c-Jun N-terminal kinase (JNK).

CONCLUSIONSXSTQ inhibits proliferation and induces apoptosis in SH-SY5Y cells. XSTQ also promotes OX1R and OX2R expression. These effects are associated with the repression of the Erk1/2, p38 MAPK, and JNK signaling pathways. These results define a molecular mechanism for XSTQ in regulating HCRT and MAPK activation, which may explain its ability to treat narcolepsy.

Apoptosis ; drug effects ; Blotting, Western ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Mitogen-Activated Protein Kinases ; metabolism ; Orexin Receptors ; metabolism ; Real-Time Polymerase Chain Reaction

BACKGROUND:Atlantoaxial anatomical structures were special. Compared with thoracolumbar vertebrae, there is no fixed anatomical marker for screw implantation. Moreover, pedicle structural variation is great. The current consensus view is to suggest an individualized program of pedicle screws. The development of orthopedic digital software technology provides a novel manner for preoperative design.
OBJECTIVE:To original y design 3D matrix model, to observe atlas pedicle channel, pedicle screw safety zone, to measure optimal program for screw fixation, and to simplify preoperative design of entering pedicle screw.
METHODS:Continuous atlas CT data of 12 healthy adults in picture archiving and communication system of People’s Hospital, Three Gorges University were imported into Mimics 10.01 software. There were seven males and five females, at the age of 30-65 years old, averagely 45 years. After three-dimensional reconstruction, the three-dimensional reconstruction models were imported into 3Dmax 2009 as .dwg format. The reference three-dimensional planes and the sites of nail insertion were determined by the atlas modeling. The modeling consisted of 17×17×2 elements and the transverse section angles ranged from 0° to 40° and the sagittal section angles ranged from 0° to 40° with a space of 2.5°. 578 elements were used to simulate pedicle screw array model. Perspective observation showed that the diameter was 3.5 mm, and length was 22 mm in pedicle channel. Thus, safety area, best screw channel and screw angle were analyzed.
RESULTS AND CONCLUSION:The total number of elements in the matrix study was 17×17×2×12 in 12 subjects. 175 screws in total of 6 936 units could safely meet the operative standard. No significant difference in the number of pedicle screw between left and right sides (P>0.05). Results indicated that the digital three-dimensional modeling technology is an effective, simple, accurate way in the preoperative design and measurement for atlas pedicle surgery.