Objective:To investigate the cognitive-related networks of patients with different cognitive impairment related to white matter lesions (WMLs), and explore the correlation between the altered functional connectivity and the executive function.Methods:Patients with white matter lesions in Beijing Tiantan Hospital from January 2016 to December 2020 were selected , who were divided into WML-non-dementia vascular cognitive impairment (WML-VCIND) group( n=19)and WML-vascular dementia (VaD) group( n=19). At the same time, 24 normal control group (NC) with no cognitive impairment with age, gender and education level matched were enrolled. The Stroop B, Stroop C, trail making test(TMT-B) and verbal fluency test (VFT) were used to evaluate the executive function of all subjects. The ICA method was used to identity four cognitive-related RSNs: frontoparietal network (FPN), salience network (SN), default network (DMN), and dorsal attention network (DAN). Using SPSS 20.0 software, the functional connectivity (FC) of the regions of interest of the selected RSNs among the three groups were compared by analysis of covariance, and correlation between the altered FCs and executive function scores were explored by Spearman correlation analysis. Results:(1) The FC of the medial prefrontal cortex (MPFC)-left inferior parietal lobe (IPL.L) in the VaD group(0.267±0.320) was significantly lower than that in the NC group (0.520±0.253)( P=0.005). The FC of MPFC-posterior cingulate (PCC) was significantly lower in the VaD group(0.655±0.284) than that in the VCIND group(0.810±0.232) ( P=0.017). The FC of MPFC-left insula and MPFC-left dorsolateral prefrontal cortex (DLPFC.L)was significantly higher in the VaD group(0.411±0.277, 0.545±0.311)than that in the VCIND group(0.239±0.308, 0.353±0.270)( P=0.044, 0.028). The FC of the left superior parietal lobe (SPL.L)-right dorsolateral prefrontal cortex (DLPFC.R) in the VCIND group(0.488±0.157) was significantly higher than that in the NC group(0.301±0.257) ( P=0.010). The FC of MPFC-left insula and MPFC-DLPFC.L was higher in NC group than that in VaD group ( P=0.020, 0.037). (2) The FC of MPFC-PCC was negatively correlated with Stroop C score ( r=-0.279, P=0.036), and TMT-B score ( r=-0.313, P=0.018). The FC of MPFC-IPL.L was negatively correlated with Stroop B score ( r=-0.311, P=0.018), Stroop C score( r=-0.308, P=0.020) and TMT-B score ( r=-0.367, P=0.005), while positively correlated with VFT score ( r=0.357, P=0.006). The FC of SPL.L-DLPFC.R was positively correlated with the Stroop B score ( r=0.305, P=0.021). Conclusion:There are certain differences in the functional connectivity between brain areas within the cognitive related brain networks, and the differences in FC between different brain areas are correlated with executive function scores. The changes of the FC may indicate possibly decline in executive function, which can explain the mechanism of cognitive declines.

Objective:To explore abnormal microstructural changes of white matter in patients with white matter lesions(WML) using diffusion tensor imaging(DTI), and to determine the association of such abnormalities of DTI parameters with executive function.Methods:Totally 34 patients with WML were recruited from the department of Neurology, Beijing Tiantan Hospital, Capital Medical University from March 2012 to May 2019.All patients with WML were scored with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA), and assessed with Montreal cognitive assessment (MoCA) and clinical dementia rating(CDR). They were divided into WML-cognitive normal group, WML-vascular cognitive impairment-non dementia group and WML-Dementia group.The Stroop color and word test (SCWT), trail making test-A (TMTA), digit symbol test and verbal fluency test were carried out to evaluate executive function.In addition, the healthy elderly without WML lesions were selected as the control group after they were examined by MRI, and all brains of the subjects went through DTI with Siemens 3.0 T MR.The data were collected and analyzed by voxel based analysis (VBA). The anisotropy and mean diffusion coefficient of DTI in the region of interest (ROI) and other regions in the brain were studied in the four groups, and their correlation with scores of executive function in WML patients was analyzed.Results:(1)In these executive function test, there were significant differences between the patients with cognitive impairment (WML-VAD group, WML-VCIND group) and normal cognition group(WML-CN group, NC group), such as SCWT(B)(65.54±6.24 vs 43.67±0.95, 76.75±2.13 vs 43.67±0. 95, 65.54±6.24 vs 43.66±1.81, 76.75±2.13 vs 43.66±1.81), SCWT(C)(88.58±6.76 vs 61.63±1.31, 96.37±1.47 vs 61 63±1.31, 88.58±6.76 vs 66.31±8.19, 96.37±1.47 vs 66.31±8.19), TMTA(40.47±2.76 vs 30.92±0.47, 44.24±1.43 vs 30.92±0.47, 44.24±1.43 vs 31.99±2.07, 40.47±2.76 vs 31.99±2.07), TMTB(88.66±6.55 vs 80.34±0.61, 96.70±1.72 vs 80.34±0.61, 88.66±6.55 vs 83.10±5.91, 96.70±1.72 vs 83. 10±5.91), Digit Symbol Test(39.25±5.63 vs 47.00±2.55, 31.27±3.93 vs 47.00±2.5, 39.25±5.63 vs 48.86±4.34, 31.27±3.93 vs 48.86±4.34) and Verbal Fluency Test(8.94±1.00 vs 11.71±0.47, 6.64±0.81 vs 11.71±0.47, 8.94±1.00 vs 10.86±0.69, 6.64±0.81 vs 10.86±0.69) scores ( P<0.05); In the patients with cognitive impairment, there were significant differences between WML-VAD group and WML-VCIND group, such as SCWT(B), SCWT(C), TMTA, TMTB, digit symbol test and verbal fluency test scores ( P<0.05); There were significant differences between WML-CN patients and NC group in the scores of SCWT (C), verbal fluency test( P<0.05). (2)FA values in the genu of corpus callosum and the inferior longitudinal fasciculus were negatively correlated with the time of SCWT (B), SCWT (C) and the TMTA( r=-0.436--0.471), but positively correlated with the scores of digit symbol test and verbal fluency test( r=0.428-0.573). MD values in the genu of corpus callosum, the superior/inferior longitudinal fasciculus and the inferior fronto-occipital fasciculus were positively correlated with the time of SCWT (B), SCWT (C) and TMTA( r=0.432~0.609), but negatively correlated with the scores of digit symbol test and verbal fluency test( r=-0.424--0.630, all P<0.003125 after emendation). Conclusion:The executive function of patients with WML-Dementia decreases significantly.The more serious the damage of white matter microstructure, the more serious the damage of executive of function.

Objective:To analyze the characteristic of nerve tracts in different stages of cognitive impairment caused by white matter hypertensities, applying diffusion tensor imaging-peak width of skeletonized mean diffusivity as evaluation indicator.Methods:Demographic characteristics and vascular risk factors of all subjects were recorded.Screened out 50 subjects without WMH and whose MoCA scale was more than or equal 26 points as normal control group.Then, we assessed 85 patients with WMH using the MoCA scale and clinical dementia assessment. Of 85 patients, 45 cases were divided into the normal cognition group, 23 cases were assigned into non-dementia vascular cognitive impairment group, and 17 cases into the vascular dementia group.The diffusion tensor imaging-peak width of skeletonized mean diffusivity marking method was used to compare the integrity of white matter fibers in WMH patients with varying degrees of cognitive impairment and normal control group.Results:The difference of PSMD among the four groups was statistically significant(CN group: 3.558±0.157, VCIND group: 4.128±0.222, VaD group: 5.469±0.000, NC group: 2.612±0.105, F=42.479, P<0.05). PSMD in WMH groups were higher than that in NC group (all P<0.05). There was no significant difference between WMH-VCIND group and WMH-CN group ( P=0.067). The PSMD of WMH-VAD group was higher than that of WMH-CN group and WMH-VCIND group (both P<0.05). Conclusion:PSMD can accurately detect white matter fiber damage caused by WMH.The degree of WMH combined cognitive decline was not completely consistent with the degree of PSMD increase.Compared with the cases with normal WMH cognition, PSMD was not significantly increased when WMH was combined with VCIND, while PSMD was significantly increased when WMH was combined with VaD.DTI-PSMD value as imaging marker can provide objective basis for clinical diagnosis of WMH-VaD.

Objective: To investigate the sources of meaning in life of the elderly in the community. Methods: The phenomenological approach was conducted in Guangzhou Yuexiu Liurong community health service center and Shouxing nursing home in Baiyun District, a total of 21 elderly were interviewed by semi-structured in-depth interviews. Interviews data were analyzed by Nvivo11. Results: The elderly in the community were less concerned about the meaning in life. The level of meaning in life ranges from nothing to high, and some elderly had not explored it yet. Sources of meaning in life for elderly were quite different from when he was young: one valued work, earn money and self-improvement more when young, but as the growth of age, one would pay more attention to family and health. The sources of meaning in life included suffering, autonomy, family, make contributions and faith. Conclusion In the future, the sense of meaning in life of the elderly can be enhanced from the perspective of individuals, families and society by identifying the sources of meaning of the elderly.

Objective To explore abnormal microstmctural changes of white matter in patients with white matter lesions using diffusion tensor imaging(DTI),and to determine the association of such abnormalities of DTI parameters with cognitive function.Methods The objects who have already confirmed with WML were collected from March 2012 to February 2018 through magnetic resonance imaging (MRI) scan from the neurology department of Beijing Tiantan Hospital.Use The hamilton depression scale(HAMD) and the hamilton anxiety scale (HAMA) to eliminate anxiety and depression,and divided into WML-CN group,WML-VCIND group and WML-VAD group with Mini-mental state examination (MMSE),Montreal Cognitive Assessment (MOCA)and clinical dementia rating(CDR).In addition,select the healthy elderly people without WML by MRI scan as the normal control group.All of the subjects were detected with the superconduct magnetic resonance imaging system (German SIEMENS 3.0T) for the DTI scanning.Original images were processed with VBA.Then explore the changes of FA and MD of DTI in whole brain and regions of interest in NC group,WML-CN group,WML-VCIND group and WWML-VAD group,and its correlation with the severity of cognitive impairment in patients with WML.Results The damage degree of the fiber microstructure of brain white matter was significantly correlated with the total grade point of MoCA (P＜0.01).In figure FA,the variance analysis of F test results showed that the significant brain areas were the splenium of the corpus callosum,the genu of corpus callosum,bilateral posterior internal capsule,retrolenticular part of internal capsule,anterior thalamic radiation,partial inferior longitudinal fasciculus and inferior fronto-occipital fasciculus,cingulate,external capsule,upper and posterior part of the radiation crowns,partial superior longitudinal fasciculus,etc.(P＜0.05 after FWE correction based on TFCE method).In Figure MD,the variance analysis of F test results showed that the statistically significant brain areas mainly included the left external capsule and hook,partial genu and splenium of corpus callosum,Bilateral,bilateral inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,anterior thalamic radiation,retrolenticular part of internal capsule,cingulate,etc (P＜ 0.05 after FWE conection based on TFCE).Conclusion No matter whether cognitive impairment exists in patient with WML or not,all DTI parameters are different from those of normal people.The integrity of white matter fiber has been damaged with different degrees.The more severe the cognitive impairment in the external manifestations of patients with WML,the greater the damage to the intrinsic white matter microstructure.

Objective:To assess the clinical value of ultrasonic imaging in combination with McGill thyroid nodules score (MTNS) system in differential diagnosis of nodule size and benign and malignant tumors.Methods: The clinical data of a total of 112 patients with thyroid nodules were analyzed retrospectively. The nidus of the patients was identified by ultrasound-guided fine needle aspiration biopsy, and then the MTNS, nodule size and false negative rate of the patients were calculated, respectively.Results: The MTNS of the 112 cases of patients with thyroid nodules was within the range of 1 to 18, with an average score of (6.83±2.31). 16 cases with malignant nodules(the percent was 14.29%) were finally diagnosed by pathology, and 96 cases were diagnosed with benign nodules(the percent was 85.71%). The MTNS of patients with malignant nodules was significantly higher than that of those with benign nodules. Ultrasonic imaging showed that the nodule diameter was within the range of 1 to 8.9cm, with an average diameter of (4.13±4.13)cm. MTNS was positively correlation with nodule diameter (r=0.146,P<0.05). Besides, the average diameter of benign nodules was (3.67±1.60)cm, and that of malignant nodules was (4.23±1.51)cm. The missed diagnosed malignant nodules mainly were large diameter nodules.Conclusion: Ultrasound imaging in combination with MTNS can better predict the benign or malignant risk of thyroid nodules.

Objective To explore the effect of leukoaraiosis (LA) on the efficiency of the brain function network and to analyze the features of the "small world" network with graph theory method.Methods This study involved 34 LA patients from the Department of Neurology,Beijing Tiantan hospital,Capital Medical University from January 2014 to September 2015 and 23 age-and sex-matched healthy controls(NC group).All participants underwent the neurocognitive tests including M MSE,MoCA and clinical dementia rating(CDR).The subjects were divided into LA with cognitive normal group (CN) (n=11) and LA patients with vascular cognitive impairment-non dementia group(VCIND) (n=23).Functional MRI (fMRI) was employed at resting state.And then,the functional network establishment and small-world network metrics (characteristic clustering coefficient and path length) were computed using graph analytical methods.Results In the range of 0.05 ≤ Kcost ≤ 0.5,the functional networks fitted the definition of small-worldness in LA (CN),LA(VCIND) and NC groups(δ＞1).The Lambda of group LA(CN) and LA (VCIND) were smaller than that of NC group at each threshold,and more closing to 1.The gamma of group LA(CN) were higher than that of NC group at each threshold.While the gamma of group LA(VCIND)were lower than that of NC group at each threshold.The sigma of group LA(CN) were higher than that of NC group at each threshold.Conclusion The LA patients exhibit abnormal small-world network properties.And compared with HCs,small world properties in LA (CN) patients have been increased,while that in LA (VCIND) patients have been reduced,which manifested that the altered topological properties may be responsible for cognitive dysfunction in LA patients.

Objective: To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. Method: A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. Result: No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). Conclusion The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.

Objective To study the influence of glycyrrhetinic acid (GA) on bronchial asthma (BA) smooth muscle proliferation and apoptosis as well as inflammatory factor expression and its molecular mechanism. Methods Male SD guinea pigs were selected and made into asthma models, bronchial asthma smooth muscle cells were cultured and divided into BA group, GA group and GA + LM group that were treated with serum-free RPMI1640 culture medium, serum-free RPMI1640 culture medium containing 50 ng/mL glycyrrhetinic acid, serum-free RPMI1640 culture medium containing 50 ng/mL glycyrrhetinic acid and 100 ng/mL LM22B-10 respectively; normal guinea pigs were collected and bronchial smooth muscle cells were cultured as control group. The cell proliferation activity as well as the expression of proliferation and apoptosis genes, inflammatory factors and p-ERK1/2 was determined. Results Proliferation activity value and mRNA expression of Bcl-2, TNF-α IL-4, IL-6, YKL-40, protein expression of p-ERK1/2 of airway smooth muscle cell in BA group were significantly higher than those of control group while mRNA expression levels of Bax, caspase-9 as well as caspase-3 were significantly lower than that of control group (P < 0.05); proliferation activity value and mRNA expression of Bcl-2, TNF-α IL-4, IL-6, YKL-40, protein expression of p-ERK1/2 of airway smooth muscle cell in GA group were significantly lower than those of BA group (P < 0.05) while the mRNA expression levels of Bax, caspase-9 as well as caspase-3 were significantly higher than those of BA group (P < 0.05); proliferation activity value and mRNA expression of Bcl-2, TNF-α IL-4, IL-6, YKL-40 of airway smooth muscle cell in GA + LM group were significantly higher than those of GA group (P < 0.05) while mRNA expression levels of Bax, caspase-9 as well as caspase-3 were significantly lower that of GA group (P < 0.05). Conclusion GA can inhibit the proliferation of bronchial smooth muscle cells and reduce the expression of inflammatory factors by inhibiting the phosphorylation of ERK1/2.

The article reviewed three aspects of hemiplegic shoulder pain after stroke-introduction, rehabilitation nursing and prospect, in order to provide references for developing effective nursing interventions in the future. We obtained literature from the Cochrane Library, JBI Evidence-based Nursing, PubMed, Wanfang and CNKI Databases between January 2000 and May 2016. According to the principle of three relevant aspects, priority to latest five years and critical appraisal, 39 studies were included. Literature analysis showed that rehabilitation nursing mainly consists of position nursing, supportive devices using, manipulative care and psychological support. Also, it put forward that comprehensive rehabilitation nursing measures have become major means, the combination of Chinese traditional and Western medicine is characteristic therapy in our nation, and nursing practice based on evidence should be set up early to relieve the symptom of hemiplegic shoulder pain and promote quality of life for stroke patients.