To analyze the mediating role of anxiety and depression in perceived social support and fatigue in ICU patients′ families, and to provide a theoretical evidence for alleviating their fatigue status. A total of 223 family members of ICU patients who received treatment at the Affiliated Hospital of Jiangnan University from October 2020 to April 2021 were selected as the study subjects. The general data questionnaire, perceived social support scale (PSSS), generalized anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9) and fatigue assessment instrument (FAI) were used to conduct a survey. Among 223 family members of ICU patients, 155(69.51%) had fatigue problems. There were statistically significant differences in total fatigue scores of ICU patients′ family members in terms of gender, age, education level, relationship with patients, residence, payment method and per capita monthly income ( P<0.05). Anxiety, depression and fatigue were negatively correlated with perceived social support ( r are -0.353, -0.276 and -0.416, respectively, all P<0.01). Depression and fatigue were positively correlated with anxiety ( r are 0.808 and 0.703, respectively, all P<0.01), and fatigue was also positively correlated with depression ( r= 0.665, P<0.01). Anxiety and depression had a partial mediating effect on perceived social support and fatigue, and the total indirect effect size was 52.64%. Comprehensive intervention on the level of social support, anxiety and depression is helpful to improve the fatigue status of ICU patients′ family members.

Objective:To evaluate the clinical features and follow-up effect of treatment for retinal capillary hemangioma (RCH) of myopic disc.Methods:Retrospective case series studies. A total of 14 patients (15 eyes) diagnosed with juxtapapillary RCH (JRCH) at Peking Union Medical College Hospital and followed up for more than 12 months from January 2007 to December 2019 were included. Among these patients, there were 7 males (7 eyes) and 7 females (8 eyes) with the average age of 29.8±12.7 years. There were 6 isolated JRCH cases, all of which were monocular patients, including 1 case with a single peripheral RCH; 8 cases with von Hippel-Lindau disease, including 5 cases of binocular RCH. Out of 15 eyes, 6 eyes were merged with peripheral RCH. Three eyes were simply observed, and 12 eyes were treated with photodynamic therapy (PDT) alone or PDT combined with other treatments. The average follow-up time was 55.2 months. Its clinical characteristics and long-term treatment effects were analyzed.Results:At the first visit, among the 15 eyes, 3 eyes had visual acuity <0.1, 5 eyes were 0.1-0.4, and 7 eyes were> 0.5. The endogenous and fixed exogenous JRCH were 12 (80%, 12/15) and 3 (20%, 3/15) eyes, respectively. The size of the tumor was 1/4 to 4 optic disc diameters (DD); the combined macular edema, epiretinal membrane, and macular hole were 11, 5, and 1 eyes, respectively. There were 3 eyes with tumor diameter less than 1 DD. The visual acuity at the first diagnosis was 0.6-1.0, and no treatment was given. The follow-up time was 12 months in 2 eyes and 120 months in 1 eye. At the last follow-up, his vision remained stable and the tumor did not enlarge. Six eyes with tumor diameter ranging from 1.0 to 2.5 DD, visual acuity was 0.06 to 0.6 at first diagnosis, accompanied by retinal exudation. 5 eyes were treated with PDT alone, and 1 eye was treated with PDT combined with anti-vascular endothelial growth factor drugs. The follow-up time was 12 to 84 months. At the last follow-up, the visual acuity improved or stabilized in 5 eyes and decreased in 1 eye. There were 6 eyes with peripheral RCH, including 4 eyes with retinal detachment, 2 eyes with epiretinal membrane, and 1 eye with vitreous hemorrhage. The visual acuity at the first visit was 0.02-0.6. All patients were treated with PDT combined with transpupillary thermotherapy, extrascleral drainage, and vitrectomy. The follow-up time was 12 to 132 months. At the last follow-up, all eyesight decreased.Conclusions:Visual decrease cause by JRCH often occurs at young adults. Bilateral JRCH are more common in patients with von Hippel-Lindau's disease. The tumor can cause retinal exudation, macular edema, epiretinal membrane and macular hole, resulting in gradual vision loss. PDT and/or combined anti-vascular endothelial growth factor drugs for medium sized JRCH with retinal exudation can maintain long-term vision stability. Patients with large JRCH or severe complications such as retinal detachment tend to have poor prognosis.

Objective:To prepare 18F-Alfatide Ⅱ automatically based on the improved CFN-100 fluorine multifunctional module and assess its PET/CT imaging in prostate cancer patients. Methods:A certain volume (200-500 μl) of fluoride ion was separated into the reaction tube by a fluoride ion separator and reacted with the labeled precursor l, 4, 7-triazacylononane-1, 4, 7-triacetic acid-E[(polyethylene glycol) 4-cyclo(Arg-Gly-Asp- D-Phe-Tyr)] 2(NOTA-E[PEG 4-c(RGDfk)] 2) (lyophilized kit). In the aqueous phase, 18F was chelated with aluminum. After being separated and purified by C18 column, 18F-Alfatide Ⅱ was prepared automatically. The radiochemical yield and its quality were analyzed. Quality control was carried out and 18F-Alfatide Ⅱ PET/CT imaging was performed in 2 patients (72 and 66 years old)with prostate cancer. Results:18F-Alfatide Ⅱ was prepared automatically by the improved CFN-100 fluorine multifunctional module combined with a double channel-fluorine ion separation device. 18F-Alfatide Ⅱ was synthetized in about 30 min, with radiochemical yield of (28±3)% (non-decay corrected, n=6). The radiochemical purity of the product was more than 98%, the specific activity was 2.8×10 7 MBq/mmol and the nuclear purity was >99%. PET/CT imaging of 2 patients showed that 18F-Alfatide Ⅱ were highly concentrated in prostate cancer lesions with the maximum standardized uptake value (SUV max) of 35.6 and 5.0, respectively. Conclusion:18F-Alfatide Ⅱ can be prepared successfully by improved CFN-100 fluorine multifunctional module with stable synthesis method, short synthesis time and high radiochemical yield, which can be highly concentrated in prostate cancer.

Objective:To explore the predictive value of complement and coagulation indicators in sepsis related acute kidney injury (AKI).Methods:Clinical data of 217 patients with sepsis admitted to the Department of Internal Medicine and Intensive Care Unit of Affiliated Hospital of Jiangnan University from January 2018 to June 2019 were retrospectively analyzed. All patients were divided into sepsis with AKI group and without AKI group. Laboratory indicators of all patients were collected, including complement C 3, complement C 4, activated partial thrombin time (APTT), prothrombin time (PT), international normalized ratio (INR), D-dimer, procalcitonin(PCT), etc. logistic regression analysis was used to explore the risk factors of sepsis related AKI. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of independent risk factors. Results:Among 217 patients, 120 patients developed sepsis related AKI and 97 patients didn′t. PCT, lactic acid, PT, APTT, INR and D-dimer in AKI patients were significantly higher than those without AKI ( P<0.01). Complement C 3 and complement C 4 were significantly lower in AKI group ( P<0.01). Multivariate logistic regression analysis suggested that blood pressure<90/60 mmHg (1 mmHg=0.133 kPa)( OR=3.705, 95% CI 1.536-8.934, P=0.004), increased lactic acid ( OR=1.479, 95% CI 1.089-2.008, P=0.012), decreased complement C 3 ( OR=0.027, 95% CI 0.005-0.152, P<0.001) and prolonged APTT ( OR=1.090, 95% CI 1.047-1.137, P<0.001)were independent risk factors predicting AKI. The area under the ROC curve (AUC) of these multivariates were 0.741 (95% CI 0.675-0.807), 0.798 (95% CI 0.732-0.864), 0.712 (95% CI 0.643-0.781) and 0.716 (95% CI 0.648-0.783) respectively. The relevant sensitivity was 57.5%, 80.8%, 87.5%, 59.2%, and the specificity was 90.7%, 75.3%, 51.5%, 77.3%, respectively. The AUC of the combined four indicators was 0.880 (95 %CI 0.835-0.926) with the sensitivity 75.0% and the specificity 90.7%. Conclusion:The low level of complement C 3 and prolonged APTT predict sepsis related AKI, and the predictive value can be enhanced if hypotension and hyperlactacidemia are added.

Objective To investigate the characteristics of 18F-Alfatide II PET/CT imaging in normal breasts and breast cancer lesions.Methods From March 2016 to August 2017,22 female patients(age:(52±10)years)with suspected breast malignant nodules or masses were prospectively enrolled.All patients underwent 18F-Alfatide II PET/CT imaging prior to biopsy or surgery.The imaging characteristics of normal breasts were assessed visually and the difference of maximum standardized uptake value(SUVmax)in normal breasts and uterus between patients with and without menopause was compared,SUVmax of cancer lesions and normal breasts was also compared.Breast cancer lesions were classified according to the distribution characteristics of radioactive uptake,and molecular subtypes ware determined by immunohistochemistry and fluorescence in situ hybridization.The SUVmax of different morphological and molecular subtypes were analyzed.Two-sample t test and Pearson or Spearman correlation analysis were used to analyze the data.Results There were 23 breast cancer lesions(one patient had bilateral breast cancer lesions and one had a history of one-side breast resection),20 normal breasts and 21 normal uteruses.Those normal breasts and uteruses didn't show any malignant change after being followed up for more than 1 year(one patient had uterine fibroids resection).There was a slight increase of radioactivity uptake in the cord-like connective tissue region at the margin of the gland in 11 mammary glands,and the SUVmax was higher than that of glandular tissue in the central region(1_81±0.67 vs 0.79±0.37;t = 6.771,P<0.00l).Of the 11 cases,except for one patient whose uterus was removed,the other 10 patients were accompanied by increased diffuse radioactivity of the uterus.SUVmax of 19 normal breast connective tissues(1.31±0.80)and uterus(3.80+1.79)were positively correlated(r = 0.785,P<0.05).For patients with/without menopause(n= 11 each group),the SUVmax of normal breast connective tissues(0.72±0.39 vs 1.81±0.67)and uterus(2.04±0.39 vs 5.11 + 1.06)were significantly different(t values:4.42 and 8.66,both P<0.01).Different levels of radioactive uptake were observed in all 23 breast cancer lesions,with SUVmax of 6.93±3.97,which was significantly higher than the nipple,connective tissue and glandular tissue of normal breasts(t values:6.784-7.559,all P<0.05).According to the characteristics of the radioactivity uptake distribution of the lesion,among the 23 breast cancer lesions,5 were mass type,3 were nodular type,4 were diffuse type,and 11 were multi-focal/multi-center type,and the SUVmax of multi-focal/multi-center type was the highest(F=3.55,P<0.05).The SUVmax of basal-like breast cancer lesions(2.49±1.67)was lower than the other three molecular subtypes.Lesions with high level human epidermal growth factor receptor 2(HER2)positive expression had higher SUVmax.Conclusions 18F-Alfatide II PET/CT imaging shows that normal breasts have a slight radioactive distribution,mainly concentrate in the nipple and connective tissues around the glandular,and the uptake have a positive correlation with the radioactive uptake of the uterus.The degree of radioactive uptake of breast cancer lesions is significantly higher than that of normal breasts.Breast cancer lesions with different moqjhological features all have obvious radioactive uptake,especially the multi-focal/multi-center type.Different molecular subtypes have different radioactive uptake levels.SUVmax is lower in basal-like breast cancer lesions,and higher in HER2 positive expression lesions.

Objective To investigate the effect of open surgical drainage approach for the treatment of walled-off pancreatic necrosis ( WOPN) in severe acute pancreatitis. Methods Clinical data of 154 WOPN patients admitted in the First Affiliated Hospital of Xinjiang Medical University from January 2005 to October 2016 were retrospectively analyzed. Traditional open debridement necrosectomy was performed in 83 patients from January 2005 to October 2012 ( debridement group) , and small abdominal incision with low-position open surgical drainage was performed in 71 patients from October 2012 to October 2016 ( drainage group ) . The clinical outcomes of two groups were analyzed and compared. Results 43 cases (51. 8％) in debridement group had postoperative intraperitoneal reinfection, while there were only 13 cases with postoperative intraperitoneal reinfection (18. 3％) in drainage group;18 cases (21. 7％) in debridement group had surgery-related digestive tract fistula, while there were only 4 cases with surgery-related digestive tract fistula (5. 6％) in drainage group; the differences were statistically significant (χ2 = 18. 55, P=0. 001; χ2 = 11. 35, P=0. 002). 15 patients (18. 1％) in debridement group and only 2 patients (2. 8％) in drainage group died. The mortality in drainage group were obviously lower than that in debridement group, and the difference was statistically significant (χ2 = 9. 07, P<0. 05 ). 62 cases ( 74. 7％) in debridement group and 55 cases (77. 5％) in drainage group were cured directly, respectively. No significant difference was found between two groups. However, 3 cases (3. 6％) in debridement group and 12 cases (16. 9％) in drainage group were cured by the way of small intestinal fistula in the late stage of intubation, and the latter was higher than the former with statistically significant(χ2 =5. 989,P=0. 014). Conclusions Compared with open debridement necrosectomy, the abdominal infection rate, digestive tract fistula rate and mortality of open surgical drainage were all significantly reduced , which may be a better treatment for WOPN.

Objective To investigate the neuroprotective effect of Benztropine on retinal ganglion cells (RGCs) death and optic nerve injury in rats model of non-arteritis anterior ischemic optic neuropathy (rNAION).Methods A total of 25 Sprague-Dawley rats were randomly divided into Benztropine treatment group (n=13)and PBS control group (n=12).The right eye was set as the experimental eye.rNAION model was established by using rose Bengal combined with laser photodynamic method.The rats in the Benztropine treatment group were received intraperitoneal injection with Benztropine 10 mg/kg (0.2 ml) daily for 3 weeks,while the rats in the PBS control group were received intraperitoneal injection with an equal volume of PBS.At 1,3 and 7 days after modeling,the retinal and optic disc conditions of the rats were observed by direct ophthalmoscopy.Retrograde labeling,fluorescence microscopy and transmission electron microscopy were used to observe the survival of RGCs and the damage of the optic nerve myelin and axon at 4 weeks after modeling.The RGCs density and survival rate of the two groups were compared by One-Way Anova.Results At 1 and 3 days after modeling,the optic disc edema was observed in the rats of rNAION model group.At 7 days after modeling,the optic disc edema decreased and the boundary was blurred compared with 3 days after modeling.After 4 weeks,the RGCs density in the PBS group was 308± 194/mm2 and the survival rate was 13.7％.The density of RGCs in the Benztropine group was 1173+868/mm2 and the survival rate was 47.6％.The differences of RGCs density and survival rate were significant between the two groups (F=7.552,8.184;P=0.015,0.012).Myelin disintegration,axon degeneration,onion-like body and gliosis were observed in the optic nerve sections of rNIAON in the PBS group,while the damage ofaxon and myelin structure in the Benztropine group was significantly less than that in the PBS group.Conclusions Benztropine group showed higher RGC survival rate,less damage ofaxon and myelin structure on rNAION model.This study explored the potential neuroprotective effect of Benztropine.

Objective To study the effect of exosomes ( EXs) released from high expression of miR-132-3p mesenchymal stem cells (MSCs) on hypoxia/reoxygenation (H/R) injured endothelial cell function. Methods MSCs extracted from bone marrow of C57BL/6 mice were cultured primarily. MSCmiR-132-3p was obtained from MSCs infected with lentivirus loaded with miR-132-3p vector. At the same time,MSCNC was obtained by infecting MSCs with control lentivirus loaded with scramble sequence. EXs released from MSCNCand MSCmiR-132-3pwas isolated,and MSC-EXs and MSC-EXsmiR-132-3pwere obtained respectively. The obtained EXs and H/R damaged mouse brain microvascular endothelial cells (bend3) were co-cultured. According to culture conditions,the cells were divided into normal culture group (normal cell culture),H/R group (making a H/R model),MSC-EXs group (MSC-EXs co-culture),MSC-EXsmiR-132-3p group (MSC-EXsmiR-132-3pco-culture), and MSC-EXsmiR-132-3p+ LY294002 group ( before the cells and MSC-EXsmiR-132-3pwere co-cultured,treated by adding phosphatidyl alcohol 3 kinase [ PI3K] signaling pathway blocker LY294002 [20 μmol/L]). Quantitative real-time quantitative polymerase chain reaction was used to detect the expression of miR-132-3p in MSCs,MSC-EXs,and bend3 cells. Angiogenesis kit was used to detect angiogenic ability of bend3 cells,and 3-(4,5-dimethylthiazole-2)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect the proliferative capacity of bend3 cells. Scratch test was used to detect the migration ability of bend3 cells. hochest33258 staining showed cell apoptosis. Western blot was used to detect the phosphorylation level of protein kinase B ( Akt) . Results Compared with the H/R group, the MSC-EXs treatment group significantly improved the angiogenesis,proliferation,migration abilities, and Akt phosphorylation level of bend 3 cell damage induced by H/R (The H/R group were 3 ± 1,0. 275 ± 0. 020,147 ± 8 μm,and 0. 89 ± 0. 12,respectively;the MSC-EXs treatment group were 8 ± 3,0. 358 ± 0. 030,218 ± 10 μm, and 1. 37 ± 0. 25 μm,respectively;all P<0. 01). Apoptosis was significantly reduced (47 ± 2% vs. 63 ± 2%,all P<0. 01). Compared with the MSC-EXs treatment group,the angiogenesis,proliferation,migration abilities,and Akt phosphorylation level of bend 3 cells in the MSC-EXsmiR-132-3ptreatment group were increased (14 ±3,0. 444 ± 0.050,357±10μm,and1.67±0.23,respectively,all P<0.01).Apoptosis was significantly reduced (34±1%,all P<0. 01) . Compared with the MSC-EXsmiR-132-3ptreatment group, cell proliferation, migration, angiogenesis abilities,and Akt phosphorylation level in the MSC-EXsmiR-132-3p+LY294002 group were significantly reduced (5 ± 2,0. 304 ± 0. 050,175 ± 8 μm and 0. 95 ± 0. 11,respectively,all P<0. 01). Conclusion MSC-EXs with high expression of miR-132-3p may improve many physiological functions of H/R-induced damaged cerebrovascular endothelial cells by activating PI3K/Akt signaling pathway.

Objective To compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.Methods Thirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender,age,axial length matched healthy volunteers (control group) were enrolled in this study.For each subject,macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured.Then 3.0 mm× 3.0 mm macular scan with SS-OCT angiography was performed,and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane.The grayscale images were then binarized for the analysis of FBFD.Results The SCT in ECS group was (394.7±77.7) μm,which was significantly thicker than (332.1 ± 68.1) μm in control group (t=2.923,P=0.008).The FBFD of intermediate choroid in ECS group were (76.35± 14.46)％,which were significantly greater than (63.57± 13.42)％ in control group (t=2.775,P=0.01).Conclusion ECS patients had increased FBFD at intermediate choroid level compared with healthy controls.

Objective To understand the changes on patterns of sleep duration of the China Health and Nutrition Survey (CHNS) cohort in 9 provinces from 2004 to 2011.Methods Four rounds of CHNS data were used.Urban/rural,age and gender specific insufficient sleeping rates and excessive sleeping rates were analyzed.Results In 2004,2006,2009 and 2011,a total of 274,281,329 and 304 children aged 3-5 years;874,806,768 and 742 children aged 6-12 years;789,529,426 and 367 children aged 13-17 years;9 568,9 530,9 942 and 9 609 adults aged ≥18 years were surveyed respectively.The lowest insufficient sleeping rate was 53.9％ (200/371) in 3-17 years old children in rural area in 2006,the highest insufficient sleeping rate was 77.2％ (44/57) in 3-5 years old children in urban area in 2004.The insufficient sleeping rate increased in rural 3-5 years old children from 2004 to 2011.For the adults aged ≥ 18 years,the insufficient sleeping rate ranged from 4.2％ (82/ 1 954) in females aged 18-44 years in 2004 and 2009 to 20.8％ (211/1 015) in urban residents aged ＞ 60 years in 2011.The insufficient sleeping rate in age-groups 44-59 years and ≥60 years increased in both males and females and in both urban area and rural area from 2004 to 2011.The gender specific excessive sleeping rate in 3-17 years old children was very low in both urban area and rural area and no difference was found in different rounds of survey.The excessive sleeping rate in adults ranged from 18.4％ (569/3 093) in urban population in 2011 to 32.5％ (1 617/4 969) in females in 2004.The excessive sleeping rate of adult decreased from 2004 to 2011.Conclusion We should pay attention to the fact that the insufficient sleeping rate in adolescents is high and in increase in rural 3-5 years old children and adults aged ≥45 years.