Objective To explore the risk factors of apathy and correlations with cognitive function in patients with hypertension combined with cerebral small vessel disease(CSVD).Methods Totally 141 patients with hypertension combined with CSVD were prospectively enrolled and were divided into apathy group(n=43)and non-apathy group(n= 98)according to neuropsychiatric inventory-apathy scale(NPI-Apathy)scores.The general data,imaging marker scores and total imaging burden scores were compared between groups.In hypertension combined with CSVD patients,multivariate logistic regression analysis was performed to screen the independent risk factors of apathy,and Spearman correlation analysis was also performed to observe the correlation of apathy and cognitive function.Results The patients'age,high density lipoprotein cholesterol(HDL-C),Fazekas scores of lateral periventricular white matter hyper-intensity(WMH),cerebral microbleed of depth/infratentorial and total imaging burden scores of apathy group were all higher,while mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scores were both lower than those of non-apathy group(all P＜0.05).HDL-C and Fazekas scores of lateral periventricular WMH were both independent risk factors for apathy(both P＜0.05),while NPI-Apathy scores were moderately negatively correlated with cognitive function in patients with hypertension combined with CSVD(r=-0.543,-0.484,both P＜0.001).Conclusion HDL-C and Fazekas scores of lateral periventricular WMH were both independent risk factors for apathy in patients with hypertension combined with CSVD.The more severe the apathy,the lower the cognitive function.

Objective:To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants.Methods:This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1 st, 2015 to December 31 st, 2021 of the Seventh Medical Center of the People′s Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children′s Hospital from January 1 st, 2020 to December 31 st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks′ corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model′s discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results:A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions:A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

Citri Reticulatae Pericarpium is a commonly used traditional Chinese medicine in China. By referring to herbal monographs and related research documents， and comparing all editions of Chinese Pharmacopoeia and local processing specifications， the processing history， modern processing specifications， study on chemical constituents and pharmacological effects before and after processing of Citri Reticulatae Pericarpium were summarized. It was found that the processing methods of Citri Reticulatae Pericarpium in the past dynasties were mainly cleansing， cutting and frying. The processing methods of Citri Reticulatae Pericarpium included in all editions of Chinese Pharmacopoeia were all cleansing and cutting. In modern local processing specifications， there were mainly processing methods such as frying， steaming and carbonizing. The components of Citri Reticulatae Pericarpium were mainly volatile oil and flavonoids. After processing， the total amount of volatile oil generally decreased， and the contents and compositions of volatile oil and flavonoids also changed. It may be the main reason for the difference of efficacy before and after processing. At present， the optimization of processing technology of Citri Reticulatae Pericarpium mainly focuses on steaming， processing with vinegar and baking. Pharmacological research on Citri Reticulatae Pericarpium mainly focuses on reducing blood lipid， relieving cough， relieving asthma and resolving phlegm， and inhibiting pulmonary fibrosis. The current research on the processing methods of Citri Reticulatae Pericarpium is not in-depth enough， the material basis of many processing methods has not been clarified， and the research on the efficacy before and after processing is not in-depth enough. Further research is needed to clarify the material basis and mechanism after the processing of Citri Reticulatae Pericarpium， so as to standardize the processing method and establish specific quality standards.

Objective? To explore the effects of WeChat combined with motivational interviewing in transitional care among young and middle-aged hypertension patients. Methods? By convenient sampling, we selected 129 young and middle-aged hypertension inpatients who were hospitalized in a classⅢ grade A hospital from June 2017 to March 2018 as subjects. All of the patients were randomly divided into observation group (n=66) and control group (n=63). In the control group we adopted routine health education and routine telephone follow-up after discharge. Apart from that, for the observation group we carried out transitional care by WeChat combined with motivational interviewing. The medication adherence was compared with the Morisky medication adherence scale, and the blood pressure control rate was observed and compared between the two groups. Results? Three months after intervention, the medication adherence of two groups all improved compared with that before intervention;the score of medication adherence of observation group and control group was (4.7±1.7) and (3.8±1.5) respectively with a statistical difference (t=3.192, P＜ 0.05). After intervention, the blood pressure control rate of observation group and control group was 60.3% and 51.5% respectively with a statistical difference (χ2=5.645, P＜ 0.05). Conclusions? Transitional care by WeChat combined with motivational interviewing can improve medication adherence and blood pressure control of young and middle-aged hypertension patients which is worthy of clinical application.

Objective To investigate the protective effect of thyroid hormone on spinal cord injury neurons and its molecular mechanism.Methods A DMEM culture medium with a volume fraction of 10％ fetal bovine serum was cultured with the dorsal ridge neurons of RN-dsc rats.The neurons were inoculated in the culture plate after the digestion of trypsin and treated differently as follows:(1) control group:DMEM treatment with no drugs or serum;(2) H2O2 group:serum-free DMEMtreatment containing 100 μmol/L H2O2;(3) H2O2 + 10-6 mol/L triiodothyronine (T3) group:serumfree DMEM treatment containing 100 μnol/L H2O2 and 10-6mol/L T3;(4) H2O2 + 10-5 mol/L T3 group:serum-free DMEM treatment containing 100 μ mol/L H2O2 and 10-5 mol/L T3;(5) negativecontrol group:transfection of negative control mimics with LipofectamineTM2000 reagent;(6) miR-210 group:transfection of miR-210 mimics with LipofectamineTM 2000 reagent.Cell viability,apoptosis number,and expressions of nuclear factor E2 correlation factor 2 (Nrf-2) antioxidant pathway molecules and miR-210 were determined.After transfection of miR-210 mimics and negative control mimics,expressions of Nrf-2 antioxidant pathway molecules were determined.Results The cell proliferation activity and protein expressions of Nrf-2,antioxidant reaction elements (ARE),superoxide dismutase 2 (SOD2),and heme oxygenase (HO-1) in H2O2 group (0.39 ±0.06,0.52 ±0.08,0.31 ±0.08,0.25 ± 0.05,respectively) were significantly lower than those in control group (1.00 ± 0.15,1.00 ± 0.17,1.00 ± 0.13,1.00 ± 0.11,respectively) (P ＜ 0.05),while the apoptosis numbers and the expressions of miR-210 were significantly higher than those in control group (P ＜ 0.05).The cell proliferation activity and protein expressions of Nff-2,ARE,SOD2,HO-1 in H2O2 + 10-6mol/L T3 group and H2O2 +10-5 mol/L T3 group were significantly higher than those in the H2O2 group (P ＜ 0.05),while apoptosis numbers and expressions of miR-210 were significantly lower than those in H2O2 group (P ＜ 0.05).The cell proliferation activity and protein expressions of Nrf-2,ARE,SOD2,HO-1 in H2O2 + 10-5mol/L T3 group (0.88 ±0.14,0.84 ±0.12,0.72 ±0.09,0.69 ±0.09) were significantly higher than those in H2O2 + 10-6mol/L T3 group (0.73 ±0.09,0.71 ±0.08,0.58 ±0.09,0.52 ±0.08) (P＜0.05),while apoptosis numbers and expressions of miR-210 were significantly lower than those in H2O2 + 10-6mol/L T3 group.The protein expressions of Nrf-2,ARE,SOD2,and HO-1 in miR-210 group (0.37 ±0.06,0.24 ±0.05,0.45 ± 0.08,0.49 ± 0.07,respectively) were significantly lower than those in negative control group (1.00±0.13,1.00±0.19,1.00±0.15,1.00±0.14,respectively) (P＜0.05).Conclusion Thyroid hormone can inhibit the expression of Nrf-2 in oxidative stress injury process of neurons by inhibiting the expression of miR-210,and hence reduce the oxidative stress injury of spinal cord neurons.

Objective The study aimed to evaluate the effects of web-problem-based learning (WPBL) in the application of Fundamental Nursing.Methods The sample was purposively selected.172 students in School of Nursing in Tianjin were recruited as the control group (n=83) and the intervention group (n=89).Traditional teaching method and WPBL was implemented in the control group and the intervention group,respectively.The teaching effectiveness of the two groups was measured by the examination and learning initiative evaluation scale and the teaching effect evaluation questionnaire,and the teaching satisfaction questionnaire was implemented among the intervention group.SPSS 18.0 was used and t test was performed to analyze the comparison between groups.Results In the theoretical examination,the scores of comprehensive analysis of the nursing students in the intervention group were better than those in the control group,and the difference was statistically significant (P＜0.05).In the evaluation of active learning after school,the scores of control learning in the intervention group were higher than those in the control group,and the difference was statistically significant ([14.78 ± 2.16),vs.(13.58 ± 2.16),t=-3.58,P=0.000].83 effective questionnaires of intervention group nursing students' teaching satisfaction were recovered.73 of them (88％) thought that WPBL could improve the students' ability of independent learning,71 students (85.5％) found that WPBL could enhance the ability of information processing,73 students (88％) thought they could communicate well with their classmates in WPBL and cooperate well to complete the task.Conclusion WPBL which is on the basis of PBL and make full use of the network,could promote the ability of autonomous learning,information processing and communication with classmates and good cooperation,but in the application process,it needs teachers to organize reasonably,perfect the supervision mechanism,and reduce taking up students' spare time.

OBJECTIVETo investigate the frequency of anaplastic lymphoma kinase (ALK) expression in non-small cell lung cancer (NSCLC) patients and its correlation with the clinicopathologic features.

METHODSALK immunohistochemistry and ALK fluorescent in situ hybridization (FISH) were performed on formalin-fixed, paraffin-embedded tissue in 100 cases of NSCLCs between 2011 and 2013. Relevant clinicopathologic data were collected and correlated with ALK expression.

RESULTSAll patients with immunohistochemical score of 3 (n = 12) were FISH-positive and all patients with score of 0 (n = 78) were FISH-negative. Among patients with immunohistochemical scores of 1 and 2, 2/3 and 6/7 were FISH-positive, respectively. The sensitivity and specificity of ALK immunohistochemistry with intensity score of 1 or more were 100% and 98%, respectively. Invasive mucinous adenocarcinoma, solid or acinar growth pattern, presence of mucous cells (signet-ring cells or goblet cells), extracellular mucus and lack of significant nuclear pleomorphism characterized ALK-rearranged cancer.

CONCLUSIONSALK-rearranged cancers possess specific histological features. Immunohistochemistry can be used as a routine test for screening ALK-positive cases in advanced NSCLC, and FISH testing should be used to confirm ALK translocation for patients with tumors showing staining for ALK by immunohistochemistry. All of these can help physicians identify patients who may benefit from targeted therapy.

Carcinoma, Non-Small-Cell Lung ; enzymology ; Female ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Lung Neoplasms ; enzymology ; Male ; Paraffin Embedding ; Receptor Protein-Tyrosine Kinases ; metabolism ; Sensitivity and Specificity

Objective To evaluate the effect of child obesity intervention comprehensive program on the improvement of overweight,obese control and knowledge-attitude-practice.Methods The study design was under cluster-randomized controlled trial,with 965 children in the intervention and 895 children in the control groups.Repeated measurement data on child obesity was analyzed through Generalized Estimating Equation models.Results The risk of becoming overweight or obesity in the intervention group was 0.824 times more than children in the control group,showing a reduction of 17.6％ the risk of being overweight or obese (P=0.031).In addition,the possibility of increasing one unit of correct rate on obesity related knowledge,children in the intervention group children was 1.044 times (P=0.001) than in the control group.On the mean obesity related correct attitude rate,it was 1.023 times (P=0.001) in the intervention group of the control group.Regarding the possibility of increasing one unit om the mean obesity related behavior score,children in the intervention group was 1.522 times (P=0.001) than those in the control group (P=0.046).Conclusion The comprehensive child obesity intervention program could effectively reduce the risk of developing overweight or obeseity and improving the obesity related knowledge,attitude and behavior in children.

Objective To investigate the effects between the modified and classic coracoid approach in infraclavicular brachial plexus nerve block.Methods Sixty patients scheduled for elective surgical procedures under infraclavicular brachial plexus block were divided into observation group and control group by table of random digit method with 30 cases each.The puncture point of control group was approach via the point 2 cm medial and caudal to the coracoid process.The puncture point of observation group was modified by surface projection of the brachial plexus.Peripheral nerve stimulator was used to confirm the proper localization of the plexus.The performance time,number of puncture,anesthesia success rate,incidence of complications and 24 h patient satisfaction were recorded.Results The performance time in observation group was less than that in control group [(3.2 ± 1.1) min vs.(4.3 ± 1.4) min](P＜ 0.05).The chance of locating the brachial plexus in a single puncture without adjusting the block needle in observation group was significantly higher than that in control group [73.3％ (22/30) vs.50.0％ (15/30)] (P ＜ 0.05).There were no statistical differences in anesthesia success rate,incidence of complications and 24 h patient satisfaction between two groups (P ＞ 0.05).Conclusions The modified coracoid approach can significantly improve the probability of locating the nerve in one puncture that reduces the performance time.It can improve the accuracy of puncture point position on the body surface.

Objective To investigate the frequency of anaplastic lymphoma kinase ( ALK ) expression in non-small cell lung cancer ( NSCLC ) patients and its correlation with the clinicopathologic features.Methods ALK immunohistochemistry and ALK fluorescent in situ hybridization ( FISH ) were performed on formalin-fixed, paraffin-embedded tissue in 100 cases of NSCLCs between 2011 and 2013.Relevant clinicopathologic data were collected and correlated with ALK expression.Results All patients with immunohistochemical score of 3 (n=12) were FISH-positive and all patients with score of 0 (n=78) were FISH-negative.Among patients with immunohistochemical scores of 1 and 2, 2/3 and 6/7 were FISH-positive, respectively.The sensitivity and specificity of ALK immunohistochemistry with intensity score of 1 or more were 100% and 98%, respectively.Invasive mucinous adenocarcinoma , solid or acinar growth pattern, presence of mucous cells ( signet-ring cells or goblet cells ), extracellular mucus and lack of significant nuclear pleomorphism characterized ALK-rearranged cancer.Conclusions ALK-rearranged cancers possess specific histological features.Immunohistochemistry can be used as a routine test for screening ALK-positive cases in advanced NSCLC , and FISH testing should be used to confirm ALK translocation for patients with tumors showing staining for ALK by immunohistochemistry.All of these can help physicians identify patients who may benefit from targeted therapy.