Depressive disorder is a mental illness characterized by poor mood and cognitive dysfunction caused by a range of complicated factors. Antidepressants have strong short-term efficacy in clinical application, yet with significant adverse effects and resistance in long-term use. Essential oils are small molecular compounds mainly composed of monoterpenes and sesquiterpenes, most of which are characterized by aromatic odors, easy permeability through the blood-brain barrier, and low toxic side effects. Volatile oil from traditional Chinese medicine can regulate neurotransmitter monoamine, hypothalamic-pituitary-adrenal axis, brain-derived neurotrophic factor, neuroinflammation and oxidative stress, and intestinal microbiota-gut-brain axis to exert an antidepressant effect through multiple pathways and targets. This review summarizes the main antidepressant chemical components of essential oil of traditional Chinese medicine, their pharmacological mechanisms and clinical application, aiming to provide some reference for further development and clinical application of essential oil of traditional Chinese medicine.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

ObjectiveTo explore the effects of mindfulness on professional identity among undergraduate nursing students in early stage of clinical internship. MethodsBy convenience sampling, 156 undergraduate nursing students on clinical internship in a ClassⅢ Grade A hospital in Harbin were selected as participants in this study. Five Facet Mindfulness Questionnaire(FFMQ), and Questionnaire for Baccalaureate Nursing Students(QBNS) were used in the study. A total of 156 questionnaires were distributed with 148 valid ones retrieved. ResultsThe 148 undergraduate nursing students got a total of (130.54±25.78) points from FFMQ, and (80.83±10.96) points from QBNS. Hierarchical regression analysis indicated that three dimensions of "mindfulness", "discription" and "non-judgement" could explain 28.1% of the variations in the undergraduate nursing students' professional identity during the early stage of clinical internship. ConclusionsThe level of mindfulness is the main influencing factor on the undergraduate nursing students' professional identity during early stage of clinical internship. Nursing educators should enhance the mindfulness training for the undergraduate nursing students in order to improve their professional identity.

Objective: To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning. Methods: Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg·kg^-1·d^-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected. Results: Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. ①Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. ② After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury. Conclusion In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.

OBJECTIVE: To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning. METHODS: Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg×kg^-1×d^-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected. RESULTS: Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. (1) Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. (2) After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury. CONCLUSIONS In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.
Adult ; Female ; Ferrocyanides ; Heavy Metal Poisoning ; Hemoperfusion ; Humans ; Male ; Middle Aged ; Thallium/poisoning*

Objective To compare the different goal-directed fluid therapy(GDFT)strategies on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy. Methods Ninety patients undergoing hepatectomy with ASA physical status Ⅱor Ⅲ were divided into three groups based on fluid treatment by random number table method:control group(conventional fluid therapy), observation group Ⅰ(GDFT filled with colloi) and observation group Ⅱ(GDFT filled with crystalloids),with 30 cases in each group.The ScvO2,Lac and Glu were tested at 5 min before anesthesia induction(T1),5 min before hepatectomy(T2),5 min after hepatectomy(T3)and the end of operation(T4). The duration of operation,fluid requirement,urinary output, bleeding volume and the use of vasoactive agent were recorded. The exhaust time, ambulation time and postoperative hospital stay were recorded. Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with that in control group,the amount of crystalloids[(1408.5 ± 348.4) ml vs. (1 819.4 ± 315.1) ml],the amount of colloids [(468.6 ± 193.4) ml vs. (1 009.7 ± 440.9) ml],the total volume[(1 867.3 ± 370.4)ml vs.(2 821.3 ± 264.6)ml]were all lower,first flatus time[(51.8 ± 8.5)h vs.(63.6 ± 9.2) h], ambulation time [(3.4 ± 0.7) d vs. (4.3 ± 0.7) d] and postoperative hospital stay [(7.8 ± 1.7)d vs.(10.5 ± 2.9)d]were all shorter,ScvO2at T3,T4was higher,Lac at T2-T4were lower,Glu at T3,T4was lower, and ALT and AST on the third day and the fifth day after surgery were lower in observation groupⅠ(P<0.05).Compared with those in observation groupⅠ,the amount of crystalloids [(2 014.7 ± 388.2)ml vs.(1 408.5 ± 348.4)ml]was increased,and the incidences of postoperative nausea and vomiting[33.3%(10/30)vs.10.0%(3/30)]were significantly higher than those in observation groupⅡ(P<0.05). Conclusions GDFT using colloids in hepatectomy probably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay. It has a much lower incidence of postoperative nausea and vomiting, compared with crystalloids.

Objective To analyze the clinical manifestation and therapeutic method in patients with acute mushroom poisoning. Methods A retrospective study was conducted. The clinical data of 48 patients with acute mushroom poisoning admitted to Department of Poisoning Treatment of the 307th Hospital of PLA from January 2016 to May 2017 were analyzed. The clinical data including gender, age, clinical symptoms, onset season, initial symptoms, incubation time, the length of hospital stay, treatment, and prognosis. In addition to the conventional treatment, the patients with severe liver damage were treated with continuous blood purification (CBP). The changes in routine blood test, biochemical parameters, blood ammonia and coagulation function before and 1, 3 and 7 days after CBP were observed. Results There were 29 of male (60.4%) and 19 of female (39.6%) in 48 patients with acute mushroom poisoning, with an average age of (48.10±13.14) years. There were 9 patients suffering from gastroenteritis type, 26 suffering from liver damage type, 8 suffering from neuro-psychosis type, 2 suffering from hemolytic type, and 3 suffering from renal damage type. All of the poisoned patients had evident seasonal characteristic, mainly concentrated in the autumn, especially in August, according for 66.7% (32/48). The initial symptoms of poisoning patients were mainly manifested as nausea and vomiting (50.0%). In five kinds of poisoned patients, the incubation time [(1.44±1.15) hours] and the length of hospital stay [(3.50±2.33) days] of neuro-psychosis type was the shortest, and the incubation time of liver-damaged type [(10.63±3.50) hours] and the length of hospital stay of renal damage type [(20.67±0.58) days] was the longest. Patients received symptomatic treatment according to different types, among whom 12 patients with severe liver damage received additional treatment for CBP. After the treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and prothrombin activity (PTA) were significantly improved as compared with those before CBP treatment, with significant differences between 7 days after CBP and before CBP [ALT (U/L): 213.08±127.30 vs. 2 766.83±1 909.66, AST (U/L): 50.00 (41.00, 85.00) vs. 2 142.00 (1 225.00, 3 126.00), CK-MB (U/L): 24.09±8.87 vs. 44.75±22.09, LDH (μmol·s-1·L-1):3.70±1.46 vs. 13.03±12.77, PTA: (79.08±24.29)% vs. (35.25±19.85)%, all P < 0.01]. Among 48 patients, 47 were cured and discharged, and 1 patient with liver failure died due to aggravation of liver dysfunction, abnormal coagulation and bleeding, and massive hemorrhage of gastrointestinal tract. Conclusions Acute mushroom poisoning patients demonstrated obvious seasonal characteristics, mostly liver-damaged type, and its initial symptoms were mainly presented as nausea, vomiting and other gastrointestinal manifestations. Early clarification of diagnosis, timely treatment, as well as providence with CBP treatment in severe patients should be carried out as soon as possible. In such a way the curative effect can be enhanced, the mortality can be reduced, and the prognosis of the patients could be improved.

Objective To study the method of the cultured human conjunctival epithelium combined with amniotic membrane transplantation for treatment of conjunctival defect. Methods 20 eyes of 10 rabbits were divided into study group (10 right eyes ) and contoal group (10 left eyes ). The conjunctival epithelium got from conjunctiva of fornix of study group about 1mm?1mm was explanted on human amniotic membrane and was cultured in vitro by tissue inoculation 2 weeks before operation. The bulbar conjunctivals of 20 eyes were excised. The conjunctival defect was covered by the graft in the study group and uncovered in the control group. The growth features of the grafts were observed. Results The conjunctival epithelium explanted on human amniotic membrane connected each other into membrane in 6 days, and multi-layer cells were observed. In the study group, all grafts were inosculated with and were similar to normal conjunctival in 2 weeks. There was not immune rejection occurred. In the control group, the conjunctival defect was recovered by scar. Conclusion It is effective of the cultured conjunctival epithelium combined with amniotic membrane transplantation for treatment of conjunctival defect.

Objective To study the culture method of conjunctival epithelium in vitro.Methods The rabbit conjunctival epithelium was cultured by tissue inoculation and was explanted in culture dish or on human amnionic membrane for fwo weeks.The cell morphology and growth features were observed.Results The rabbit conjunctival epithelium explanted in culture dish connected each other into membrane at eighth days around,which were monolayer cells was observed.The rabbit conjunctival epithelium explanted on human amnionic membrane connected each other into membrane at sixth day,and multi-layer cells were observed.All cultured cells showed positive in CK13 staining by indirect immunofluorescence staining.Conclusions Tissue inoculation is a good approach of conjunctival epithelium culture,and multi-layer cells can be gained if the tissue be exlpanted on human amnionic membrane.

[Objective]To explore the treatment of intertrochanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications.[Method]Fifty-eight cases of closed intertrochanteric fracture,including 28 male cases and 30 female,average 73.2 years old(range from 42 to 88)accepted treatment.The type of fracture according to Evans classification:5 cases were type Ⅰ,7 were type Ⅱ,28 were type Ⅲ,13 were type Ⅳ,and 5 were type Ⅴ.All cases were treated with expandable proximal femoral intramedullary nail after close reduction.[Result]Thirty-eight cases were followed up,from 12 to 36 months,average 18.5 months,all of the cases got clinical healing after 8-10 weeks postoperatively.Hip Harris score average was 91.8.Some complications occurred in 6 cases:1 case had secondary fracture nearby the greater trochanter needling insertion point,1 case femoral head peg was outside of the lock hole,and 1 case femoral head peg tip was broken during operation.And after operation,1 case had coxa vara deformation,1 case had femoral middle and superior segment fracture,and 1 case femoral head peg was exited.[Conclusion]Expandable proximal femoral intramedullary nail has some advantages as:minimal invasive,manipulation convenient,fixation reliability,remove easily,but surgeons must be familiar with the construction and fixation principle of the nail in the primary stage,and perform the operating instruction strictly,to reduce or avoid the complications occurrence because of mis-manipulation.