Objective:To investigate the effect of problem-solving therapy (PST) on clinical efficacy, cognitive and social function in senile patients with first episode depression.Methods:From March 2020 to August 2021, a total of 86 patients with first onset elderly depression treated in the geriatric department of Qingdao Mental Health Center were selected. According to the random number table method, totally 86 patients were randomly divided into a study group and a control group, with 43 cases in each group. The control group was treated with antidepressant drugs and basic psychiatric nursing intervention. The study group received PST treatment on the basis of the control group for 8 weeks. The Hamilton depression scale-17 items(HAMD-17), Montreal cognitive assessment scale (MoCA), and social dysfunction screening scale (SDSS) were used to assess the degree of depression, cognitive function and social function in both groups. SPSS 18.0 was used for statistical analysis. Independent sample t-test was used for comparison between groups, paired sample t-test was used for comparison before and after treatment. Results:After 8 weeks of intervention, HAMD-17 scores and SDSS scores in the two groups were both significantly decreased compared with before intervention, and the differences between pre intervention and post intervention had statistical significance( t=3.067, 22.543, both P<0.05), while MoCA scores were significantly increased, and the difference between pre intervention and post intervention had statistical significance ( t=9.623, P<0.05). Compared with the control group after 8 weeks of intervention, the HAMD-17 score ((14.44±1.97), (15.58±2.66), t=2.260, P=0.026) and SDSS score((9.44±2.24), (13.00±1.73), t=8.242, P<0.001) of the study group were lower, and the score of MoCA ((25.44±1.28), (23.84±1.56), t=5.223, P<0.001) was higher. Conclusion:In addition to conventional antidepressant therapy, PST not only reduces the severity of depression in elderly patients with first episode depression, but also significantly improves their cognitive and social function.

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.

Objective:To explore the value of 18F-FDG PET/CT combined with pro-gastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) in diagnosis and differential diagnosis of stageⅠA small cell lung cancer (SCLC). Methods:From June 2017 to October 2021, 113 patients (75 males, 38 females; age 32-79 years) with stageⅠA lung cancer (70 with adenocarcinoma, 25 with squamous cell carcinoma, 18 with SCLC; patients with adenocarcinoma and squamous cell carcinoma were combined into non-SCLC (NSCLC) group) and 30 patients with benign pulmonary nodule (21 males, 9 females; age 37-77 years) from the Affiliated Qingdao Central Hospital of Qingdao University were retrospectively analyzed. All patients were examined by 18F-FDG PET/CT and serum tumor markers associated with lung cancer. Differences of the clinical, imaging and tumor markers data among different groups were analyzed by χ2 test, Fisher exact test and Kruskal-Wallis rank sum test. Independent risk factors were analyzed by logistic regression analysis and ROC curve analysis was used to analyze the value of different predictive factors in diagnosis and differential diagnosis of SCLC. Results:There were significant differences in SUV max, lobulation sign, spiculation sign, calcification, pleural traction sign, ProGRP, NSE and carcinoembryonic antigen (CEA) among SCLC, NSCLC and benign nodules groups ( H values: 14.06-20.54, χ2 values: 8.16-14.95, all P<0.05), in which lobulation sign of SCLC was more than that of benign nodules (12/18 vs 26.7%(8/30); χ2=7.41, P=0.007), spiculation sign (2/18 vs 51.6%(49/95); χ2=10.01, P=0.002) and pleural traction sign (1/18 vs 35.8%(34/95); χ2=6.47, P=0.011) were less than those of NSCLC, SUV max was higher than that of benign nodules (7.4(5.8, 9.0) vs 2.3(1.4, 5.1); H=51.82, P<0.001), ProGRP was higher than that of NSCLC and benign nodules (64.0(40.1, 84.8) vs 38.7(26.9, 47.6), 36.7(29.1, 40.5) ng/L; H values: 36.13, 43.96, P values: 0.002, 0.001) and NSE was higher than that of benign nodules (12.4(10.9, 14.5) vs 7.4(5.4, 11.8) μg/L; H=40.53, P=0.001). When differentiated SCLC from NSCLC, spiculation sign (odds ratio ( OR)=0.043, 95% CI: 0.004-0.450, P=0.009) and ProGRP ( OR=1.083, 95% CI: 1.035-1.133, P<0.001) were independent risk factors for SCLC, and the AUC of the two factors combination was 0.875, with the sensitivity and specificity of 14/18 and 84.2%(80/95). When differentiated SCLC from benign nodules, SUV max( OR=2.706, 95% CI: 1.099-6.662, P=0.030), ProGRP ( OR=1.165, 95% CI: 1.009-1.344, P=0.038) and NSE ( OR=1.639, 95% CI: 1.016-2.645, P=0.043) were independent risk factors for SCLC, and the AUC of the three factors combination was 0.985, with the sensitivity and specificity of 17/18 and 96.7%(29/30). Conclusion:18F-FDG PET/CT combined with tumor markers ProGRP and NSE is helpful to improve the diagnosis and differential diagnosis of stage ⅠA SCLC.

OBJECTIVE To study the pharmacokinetics and pharmacodynamics of oral colon targeted pH-sensitive hydrogel of hydrocortisone sodium succinate(HSS-GEL). METHODS The plasma concentration changes of HSS-GEL and HSS in the mice were investigated; 2, 4, 6-trinitrobenzene sulfonic acid(TNBS)-induced mouse model of ulcerative colitis(UC) was established, disease activity index(DAI), colon length, myeloperoxidase(MPO) and organ index were used as indicators to investigate the therapeutic effect of HSS-GEL on colitis. RESULTS The results showed that the Tmax, Cmax and AUC of HSS-GEL were significantly different from those of HSS(P<0.01). The Tmax of HSS-GEL was significantly longer than that of HSS, and the time of drug absorption into the blood was significantly delayed. The Cmax of HSS-GEL group was significantly lower than that of HSS. The AUC of the HSS-GEL group was 39.38% of the same dose of HSS, indicating that the amount of the drug absorbed into blood was significantly reduced after the HSS was made into HSS-GEL orally. After modeling, DAI, MPO activity and organ index were increased, while the colon was shortened due to the inflammatory reaction, with the treatment of HSS-GEL, DAI, MPO activity and some organ index of mice were significantly decreased comparing with TNBS group(P<0.05 or P<0.01). The degree of reduction of MPO activity and some organ indexes of the mice in the TNBS+HSS-GEL group were significantly greater than those in the TNBS+HSS group, indicating that HSS-GEL had good therapeutic effect on TNBS-induced ulcerative colitis, and the effect was better than that of HSS. CONCLUSION The HSS-GEL prepared has good colon targeting characteristic and colitis treatment effect.

Objective To observe the value of 18F-FDG PET/CT combined with tumor markers for diagnosis of non stageⅠ A limited-stage small cell lung cancer(LS-SCLC).Methods Totally 87 cases of non stage Ⅰ A LS-SCLC(LS-SCLC group),137 of non stage Ⅰ A non-small cell lung cancer(NSCLC,NSCLC group)and 48 cases of pulmonary inflammatory lesions(inflammatory group)were enrolled.Patients'general data,tumor marker levels and PET/CT findings were comparatively analyzed.Logistic regression analysis was performed to evaluate the efficacy of parameters for diagnosing non stage Ⅰ A LS-SCLC.Results There were significant differences of patients'age,neuron-specific enolase(NSE),pro-gastrin-releasing peptide(ProGRP),carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCCA)and cytokeratin-19-fragment(CYFRA21-1),as well as of the maximum lesion diameter,maximum standard uptake value(SUVmax),morphology,spiculation sign,relationship between long axis and bronchus,lymph node fusion and proportion of lymph node with higher SUVmax than primary lesion among 3 groups(all P＜0.05).The area under the curve(AUC)of the combination of spiculation sign,NSE＞23.5 μg/L,ProGRP＞111.8 ng/L,SCCA≤2.5 μg/L and CYFRA21-1≤7.4 μg/L for differentiating LS-SCLC and NSCLC was 0.91,higher than that of each single parameter(all P＜0.05).AUC of the combination of SUVmax＞8.1,NSE＞19.4 μg/L,ProGRP＞72.5 ng/L and lymph node fusion for differentiating LS-SCLC and pulmonary inflammatory lesions was 0.99,higher than each single parameter(all P＜0.05).Conclusion 18F-FDG PET/CT combined with tumor markers ProGRP and NSE was helpful for diagnosing non stage ⅠA LS-SCLC.

To explore the characteristics and gender differences of non-motor symptoms（NMS） in De Novo Parkinson’s diseases （PD）. Methods 203 newly diagnosed PD patients （102 males，101 females） and 255 healthy controls （110 males，145 females） were selected. The clinical data were collected and evaluated by mini-mental State Examination （MMSE），Montreal Cognitive Assessment （MoCA），Hamilton Depression Scale （HAMD），Hamilton Anxiety Scale （HAMA），Parkinson’s disease Sleep Scale （PDSS），Unified PD Rating Scale Part III （UPDRS-III） and Hoehn Yahr （H-Y） stage. Non-motor questionnaire screening scale （NMSQ） was used to assess their non-motor symptoms，and compared the characteristics of NMS in different genders. Multivariate linear regression was used to analyze the influencing factors of NMDQ score in PD patients. Results 98.5% of PD patients had at least one NMS，among which forgetfulness （ 67.5%），depression （49.8%） were the most common. The total score and nine domains of NMS in PD group were significantly higher than those in healthy controls （all P<0.05）. The rates of interest decline，depression，anxiety and excessive sweating in female in PD group were significantly higher than those in male，while the rate of dysphagia was significantly lower （all P<0.05）. The rates of hallucination and sweating increase in female in healthy controls were significantly higher than those inmale，the rate of memory decline was significantly lower （all P<0.05）. The total scores of NMS in male and female patients with PD were affected by HAMD and PDSS （all P<0.05），while male patients were more likely to be affected by the disease duration （β= 0.181，P=0.032）. Conclusion The incidence of non motor symptoms in newly diagnosed PD patients is significantly higher than that in healthy controls and different in gender.

Objective:To explore the value of 18F-fluorodexyglucose (FDG) PET/CT combined with integrated contrast-enhanced CT on the diagnosis of hepatic epithelioid hemangioendothelioma(HEH). Methods:Six patients (2 males, 4 females, age: (41.0±5.6) years) histopathologically confirmed to be HEH in Qingdao Central Hospital between November 2013 and November 2018 were retrospectively analyzed. All patients underwent 18F-FDG PET/CT dual-phase imaging and three-phase dynamic enhanced scanning with integrated CT. Characteristics of 18F-FDG PET/CT and contrast-enhanced CT images were classified and analyzed. Results:All 6 patients had multi-lesions (30 lesions in total). The capsule retraction sign was found in 16.7% (5/30) lesions, target sign was found in 33.3% (10/30) lesions, and " lollipop sign" was found in 13.3% (4/30) lesions. There were three ways of enhancement showed by CT: mild progressive enhancement, delayed enhancement, and black target sign/white target sign in the portal phase. Among the 30 lesions, 66.7% (20/30) had higher 18F-FDG uptake than liver parenchyma, with maximum standardized uptake value (SUV max) of 4.18±0.64 during routine imaging and 4.23±0.70 during delayed imaging, and the retention index was 0.65(-1.88, 4.60). The rest 33.3% (10/30) showed similar 18F-FDG uptake to liver parenchyma, with SUV max of 2.75±0.52 during routine imaging, and 2.78±0.55 during delayed imaging. The uptake of 18F-FDG increased with time in 22 lesions and decreased in 8 lesions. In the metabolically heterogeneous lesions, the relatively high-metabolization site was also the site with higher peak enhancement; in the lesions with uniform metabolism, the CT enhancement was also uniform. Bilateral pulmonary metastases were found in 2/6 patients. Conclusion:18F-FDG PET/CT dual-phase imaging combined with CT three-phase dynamic enhanced scanning is helpful in accurate diagnosis of HEH and could show extrahepatic metastases.

Objective To investigate CT and MRI features of hepatic sclerosed hemangioma (HSH).Methods CT and MRI findings were retrospectively reviewed in 20 cases of HSH,all of which were confirmed pathologically after hepatic surgery.Twenty patients underwent CT scan,4 patients underwent MRI.Meanwhile,the enhancement pattern and signal intensity were analyzed either.Results Twenty patients showed main part of tumor was hypo-attenuating on CT plain scanning,and 16 patients showed the central area of tumor was markedly more hypo-attenuating on CT plain scanning.After administration of intravenous contrast media,multifocal linear or small nodular enhancement in the peripheral area was seen during the arterial phase on 16 patients of HSH.Venous phases showed centripetal enhancement or spread around the nodules enhancement which continued to delayed phases with low density of no enhancement in the lesion area.Four patients showed no obvious enhancement on arterial phases and slight separation sample enhancement at the edge or inside of the lesions with a wide range of non enhancement areas on venous phase and delayed phase.Four patients were performed MRI examination,the lesions demonstrated hypointensity with a lower signal area on T1WI,hyperintensity with a higher signal intensity area on T2WI.The DWI sequence of b value were 0,150,800 s/mm2,all of which were obviously hypointensity.The edge of lesions showed small nodular enhancement on arterial phase,irregular concentric enhancement on venous phase and delayed phase,and there was no enhancement area with lower signal in the center of the lesion.Conclusions The enhancement pattern of HSH different from cavernous hemangioma,with a larger non enhancement area in the center of the lesions and similar to other hepatic masses with central scar,differential diagnosis dependence on CT and MRI dynamic enhanced scan.

Objective To explore the application of three dimensionally structured nursing management mode in the treatment of multiple trauma patients. Methods One hundred and eighty-seven patients with multiple injuries in the emergency department of our hospital from January to December 2010 were set up as the control group, and the traditional method was used in the group. Another 189 patients with multiple injuries from January to December 2011 were set as the observation group , in which the three dimensionally structured nursing management mode was used. The two groups were compared in terms of success rate. Result The success rates of the observation group and the control group were 85.7%(162/189) and 71.7%(134/187), respectively. The difference between the two group was statistically significant (Χ2=19.19,P<0.01). Conclusion The implementation of the three-dimensionally structured nursing management model can improve the comprehensive ability of emergency treatment and then improve the success rate of rescuing emergency patients.

Previous studies proposed that the synergistic effect of fibroblast growth factor-21 (FGF-21) and insulin may be due to the improvement of insulin sensitivity by FGF-21. However, there is no experimental evidence to support this. This study was designed to elucidate the mechanism of synergistic effect of FGF-21 and insulin in the regulation of glucose metabolism. The synergistic effect of FGF-21 and insulin on regulating glucose metabolism was demonstrated by investigating the glucose absorption rate by insulin resistance HepG2 cell model and the blood glucose chances in type 2 diabetic db/db mice after treatments with different concentrations of FGF-21 or/and insulin; The synergistic metabolism was revealed through detecting GLUT1 and GLUT4 transcription levels in the liver by real-time PCR method. The experimental results showed that FGF-21 and insulin have a synergistic effect on the regulation of glucose metabolism. The results of real-time PCR showed that the effective dose of FGF-21 could up-regulate the transcription level of GLUT1 in a dose-dependent manner, but had no effect on the transcription level of GLUT4. Insulin (4 u) alone could up-regulate the transcription level of GLUT4, yet had no effect on that of GLUT1. Ineffective dose 0.1 mg kg(-1) FGF-21 alone could not change the transcription level of GLUT1 or GLUT4. However, when the ineffective dose 0.1 mg x kg(-1) FGF-21 was used in combination with insulin (4 u) significantly increased the transcription levels of both GLUT1 and GLUT4, the transcription level of GLUT1 was similar to that treated with 5 time concentration of FGF-21 alone; the transcription level of GLUT4 is higher than that treated with insulin (4 u) alone. In summary, in the presence of FGF-21, insulin increases the sensitivity of FGF-21 through enhancing GLUT1 transcription. Vice versa, FGF-21 increases the sensitivity of insulin by stimulating GLUT4 transcription in the presence of insulin. FGF-21 and insulin exert a synergistic effect on glucose metabolism through mutual sensitization.