1.Pharmacodynamic Characteristics and Neuroinflammatory Mechanisms of Ruyi Zhenbaowan in Treating Nociceptive Hypersensitivity and Central Sensitisation of Spinal Cord in Mouse Model of Central Post-stroke Pain
Aoqing HUANG ; Wenli WANG ; Ying LIU ; Hai ping WANG ; Chunyan ZHU ; Na LIN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(24):36-46
		                        		
		                        			
		                        			ObjectiveTo clarify the pharmacodynamic characteristics and neuroinflammatory mechanisms of Ruyi Zhenbaowan (RYZBW) in treating nociceptive hypersensitivity and central sensitisation of spinal cord in the mouse model of central post-stroke pain (CPSP). MethodSPF-grade male ICR mice of 8 weeks old were assigned into the sham operation (Sham), model (CPSP), low-, medium-, and high-dose (0.303, 0.607 1.214 g·kg-1) RYZBW (RYZBW-L, RYZBW-M, and RYZBW-H, respectively), and pregabalin (PGB, 0.046 g·kg-1, positive control) groups. The rat model of CPSP was established by injection of type Ⅳ collagenase into the ventral posterior lateral nucleus of the thalamus on day 1. Rats were administrated with corresponding drugs or normal saline (Sham and CPSP groups) by gavage from day 14 to day 17. The mechanical pain sensitivity test was performed on days 0, 3, 4, 7, 10, 14, 17. On day 18, the L5 segment of spinal cord was collected for the detection of inflammatory cytokines by immunoinflammatory microarray, CXC chemokine ligand 16 (CXCL16) by enzyme-linked immunosorbent assay, and calcitonin gene-related peptide (cGRP) by immunohistochemistry. In addition, fluorescence dual-labeling was employed to determine the expression levels of CXCL16, the dendritic cell marker CD11c, the macrophage marker CD68, the microglia marker TMEM119, the endothelial cell markers CD31 and CXCR6, and the T cell marker CD3. ResultCompared with the Sham group, the mechanical pain threshold of the CPSP group was significantly lower than that of the Sham group from day 3 to day 17, with stable hyperalgesia symptoms. On the 7th day, the mechanical pain threshold of the PGB group was significantly higher than that of the CPSP group, with significant analgesic effect (P<0.01). On days 10-17, the mechanical pain threshold of the RYZBW-H group was significantly higher than that of the CPSP group, showing a stable analgesic effect (P<0.05). On the 17th day, the analgesic effect of RYZBW was dose-effect correlated (R2=0.303 7). From day 4 to day 17, the mechanical pain threshold of RYZBW-H group was positively correlated with time (R2=0.111 5). The above results suggested that the analgesia of RYZBW was time-dependent. On the 17 th day, the expression of central sensitization marker cGRP in the spinal dorsal horn of CPSP mice was significantly increased compared with the Sham group (P<0.05), and RYZBW down-regulated it in a dose-dependent manner (R2=0.500 8), suggesting that RYZBW significantly inhibited the central sensitization of the spinal cord caused by CPSP. The results of spinal cord inflammation chip on the 17th day showed that compared with CPSP group, RYZBW-H group inhibited CXCL16 expression (P<0.01).The results of ELISA based on independent repeated samples showed that RYZBW inhibited the expression of CXCL16 protein in spinal cord in a dose-dependent manner (R2=0.250 4). The results of immunofluorescence double labeling showed that compared with Sham group, the expression of CXCL16 in CD11c positive dendritic cells in CPSP group increased, and the number of CD68 positive cells increased (P<0.05). Compared with CPSP group, RYZBW down-regulated it: the expression of CXCL16 in CD31 positive endothelial cells, CD68 positive macrophages and TMEM119 positive microglia increased, and the number and cell body area of TMEM119 positive microglia increased significantly (P<0.05). The number of CD3 positive T cells (P<0.05) and the expression of CXCR6 in CD3 positive T cells were increased. RYZBW inhibited the activation of endothelial cells and macrophages in a dose-dependent manner, and reduced the infiltration of microglia and T cells (R2=0.691 4, R2=0.551 5, R2=0.653 2, R2=0.180 6, R2=0.287 5, R2=0.298 6,R2=0.511 6). ConclusionRYZBW can effectively alleviate nociceptive hypersensitivity and central sensitisation of the spinal cord in CPSP mice by regulating CXCL16-CXCR-6, inhibiting the infiltration and activation of microglia and macrophages, and the activation of dendritic cells, endothelial cells, and T cells. 
		                        		
		                        		
		                        		
		                        	
2.Effect and Immunoinflammatory Mechanism of Ruyi Zhenbaowan in Treatment of Secondary Brain Injury and Central Pain in Hemorrhagic Stroke Mice
Wenli WANG ; Guoxin ZHANG ; Ying LIU ; Na LIN ; Chunyan ZHU ; Ya LIN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(24):47-56
		                        		
		                        			
		                        			ObjectiveTo evaluate the intervention effect of Ruyi Zhenbaowan (RYZBW) on secondary brain injury and central pain in mice with hemorrhagic stroke and to explore its pharmacological mechanism of repairing the neurovascular unit from the perspective of neuroinflammation. MethodA mouse model of central post-stroke pain (CPSP) was established by microinjecting type Ⅳ collagenase into the ventroposterior thalamic nucleus. The day of model establishment was recorded as D1, and the mice were divided into Sham operation group (Sham), model group (CPSP), low (RYZBW-L), medium (RYZBW-M), and high (RYZBW-H) dose groups of RYZBW, and positive drug pregabalin (PGB) group. On the 4th day (D4) after model establishment, gavage administration was performed twice daily. The Sham and CPSP groups received an equal volume of normal saline, while the RYZBW-L, RYZBW-M, and RYZBW-H groups received RYZBW at 1.214, 1.821, 2.428 g·kg-1, respectively, and the PGB group received PGB at 0.046 g·kg-1. Mechanical hyperalgesia was assessed before model establishment (D0), on the 3rd day (D3), and after the first gavage on D4. Nerve damage was evaluated after the second gavage on D1 and D4. On D4, peripheral blood was collected for routine blood tests, and the thalamus was collected for immune-inflammation microarray analysis. In independent samples, quantitative analysis was performed on the localization of immune-inflammatory factors, receptors, and cells via immunofluorescence staining, enzyme-linked immunosorbent assay (ELISA), and Western blot analysis. ResultCompared with the Sham group, CPSP mice showed significant secondary nerve injury, central pain after stroke (P<0.05,P<0.01), increased red blood cell distribution width (RDW) in peripheral blood (P<0.05), and decreased hemoglobin (HGB) concentration (P<0.05). Immune-inflammation microarray analysis showed that CC chemokine ligand 2 (CCL2) in the CPSP thalamus was significantly increased compared to the Sham group (P<0.01), while CX3C chemokine ligand 1 (CX3CL1) was significantly decreased (P<0.05). These results were confirmed by ELISA and immunofluorescence staining. Western blot analysis indicated that the protein expression of CX3CR1, the receptor for CX3CL1, was significantly decreased in the CPSP group compared to the Sham group (P<0.01). Immunofluorescence staining revealed that the number of Ly6C+CX3CR1+ non-classical monocytes in the CPSP group did not change significantly, while the number of classical monocytes (CX3CR1-Ly6C+) significantly increased (P<0.01). The expression of CX3CR1 in microglia was significantly increased in the CPSP group (P<0.01). Compared with the CPSP group, RYZBW improved neurological deficits (R2=0.367 9) and central pain symptoms (R2=0.501 9) in a dose-dependent manner. RYZBW-H significantly improved peripheral blood RDW and HGB (P<0.05). Immune-inflammation microarray analysis and ELISA results showed that RYZBW-H significantly inhibited CCL2 expression (P<0.01) and increased CX3CL1 expression (P<0.05). Western blot results indicated that the protein expression of CX3CR1 in the RYZBW-L and RYZBW-H groups was significantly increased (P<0.05). Immunofluorescence staining demonstrated that RYZBW increased the overall expression of CX3CR1 in a dose-dependent manner (R2=0.619 6), inhibited the expression of CX3CR1 on microglia, and decreased both the number (R2=0.494 5) and soma area (R2=0.571 7) of microglia compared with the CPSP group. Additionally, RYZBW increased the infiltration of CX3CR1+Ly6C+ non-classical monocytes in a dose-dependent manner (R2=0.635 3) and effectively inhibited the infiltration of Ly6C+CX3CR1- classical monocytes (R2=0.483 6). ConclusionRYZBW can effectively alleviate secondary injury and central pain in CPSP mice, and its mechanism involves regulating the CX3CL1-CX3CR1 ligand-receptor interaction, inhibiting microglial infiltration and activation, promoting non-classical monocyte infiltration for vascular repair, and suppressing the infiltration of classical monocytes for inflammatory phagocytosis. 
		                        		
		                        		
		                        		
		                        	
3.Development of a random forest prediction model for perineural invasion in gallbladder carcinoma based on preoperative enhanced CT image features
Min YANG ; Qi LI ; Wenli HUO ; Wenzhi LI ; Na LI ; Zhimin GENG ; Jian YANG
Chinese Journal of Hepatobiliary Surgery 2024;30(8):581-585
		                        		
		                        			
		                        			Objective:To construct a random forest prediction model for non-invasive identification of perineural invasion in gallbladder carcinoma (GBC) based on preoperative enhanced CT imaging features.Methods:The clinical data of 180 patients who underwent curative-intent resection for gallbladder carcinoma at the First Affiliated Hospital of Xi′an Jiaotong University from January 2022 to December 2023 were retrospectively analyzed, including 61 males and 119 females with the age of (65.3±10.2) years old. The 180 patients were divided into a training set ( n=126) and a testing set ( n=54), and based on perineural invasion, the 126 patients in the training set were divided into the perineural invasion group ( n=33) and the non-perineural invasion group ( n=93), and the other 54 patients in the testing set, there were 15 patients with perineural invasion and 39 patients without perineural invasion. Clinical data such as gender, age, perineural invasion, carbohydrate antigen 19-9 (CA19-9) level and tumor stage were collected from patients. Multivariate logistic regression model was used to analyze the risk factors of perineural invasion in gallbladder carcinoma patients. The correlation between clinical variables and perineural invasion was ranked in order of importance using the "feature_importance" package in Python software. Then, we developed a random forest prediction model for perineural invasion in gallbladder carcinoma patients, and the area under the receiver operating characteristic (ROC) curve and confusion matrix were used to assess the predictive ability of the model. Results:Multivariate logistic regression model analysis showed that patients with CA19-9 >39.0 U/ml ( OR=5.165, 95% CI: 1.650-16.174), T3 stage ( OR=6.037, 95% CI: 1.571-23.197), T4 stage ( OR=9.996, 95% CI: 2.177-45.898), and lymph node metastasis ( OR=7.829, 95% CI: 2.705-22.627) were with a high risk of perineural invasion occurrence (all P<0.05). The top three variables in the order of the importance ranking were CA19-9, lymph node metastasis, and T stage. Combining the results of multivariate analysis and importance ranking, CA19-9, lymph node metastasis, and T stage were used to develop a random forest prediction model for perineural invasion in gallbladder carcinoma patients. The results of ROC curve analysis showed that the areas under curves of the random forest model in the training and testing sets were 0.8250 and 0.7667, respectively. The confusion matrix results showed that the sensitivity were 75.76% and 73.33%, the specificity were 80.65% and 76.92%, and the accuracy were 79.36% and 75.93% in the training and testing sets, respectively. Conclusion:Random forest prediction model based on preoperative enhanced CT image features can be used as a noninvasive means of identifying perineural invasion in patients with gallbladder carcinoma.
		                        		
		                        		
		                        		
		                        	
4.Correlation of serum ADAMTS-4 and aβ2-GPl levels with white matter lesions in elderly patients with acute cerebral infarction
Wenli NA ; Xiangdong BAI ; Yan BAO
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2024;26(11):1325-1328
		                        		
		                        			
		                        			Objective To explore the correlation of serum levels of ADAMTS-4 and aβ2-GP1 anti-body with WML in elderly patients with ACI.Methods A retrospective study was conducted on 200 elderly ACI patients admitted in Department of Neurology of from January 2022 to January 2024.Based on Fazekas scoring,they were categorized into the control group(n=32),mild group(n=96),moderate group(n=49),and severe group(n=23).Their neurological function and ser-um levels of ADAMTS-4 and aβ2-GP1 were compared among the different groups.Results The NIHSS score and serum levels of ADAMTS-4 and aβ2-GP1 were significantly higher in the severe group than the moderate group,mild group and control group in order,and statistical difference were observed among them(P<0.05).Serum ADAMTS-4 and aβ2-GP1 levels were significantly positively correlated with the severity of WML(P<0.05).Serum ADAMTS-4 and anti-β2-GP1 were influencing factors for the occurrence of WML in elderly ACI patients(OR=2.149,95%CI:1.375-3.360,P=0.001;OR=1.702,95%CI:1.185-2.446,P=0.004).Conclusion The levels of serum ADAMTS-4 and aβ2-GP1 are closely related to the severity of WML and nerve damage in elderly ACI patients.
		                        		
		                        		
		                        		
		                        	
5.Clinical characteristics and genetic analysis of CYP7B1 gene mutation-associated complex hereditary spastic paraplegia pedigrees
Yuwei ZHANG ; Jiewen ZHANG ; Guiyu LOU ; Bing ZHANG ; Yusheng CHEN ; Wenli MEI ; Na QI ; Xingxing LEI ; Ke YANG
Chinese Journal of Neurology 2024;57(8):881-889
		                        		
		                        			
		                        			Objective:To analyze the clinical phenotype and genetic characteristics of probands in 3 pedigrees of complex hereditary spastic paraplegia type 5 (HSP5) who developed symptoms during childhood, and the genetic diagnostic methods of HSP5 to improve the diagnosis and differential diagnosis of this disease.Methods:The clinical data of 3 HSP5 families admitted to Henan Provincial People′s Hospital from June 2020 to January 2023 were collected. Whole exome sequencing (WES) was performed on the patients to analyze phenotype-related single nucleotide variation (SNV) and small fragment insertion/deletion (INDEL) variation. At the same time, the sequencing data were used to analyze the dynamic mutation regions of specific genes.Results:The probands in the 3 families had complex HSP: the proband in family 1 showed weakness of both lower limbs, urgency of urination and ataxia; the proband in family 2 showed slightly lower intelligence, weakness of both lower limbs, dysarthria, and brain magnetic resonance imaging showed white matter lesions; the proband in family 3 showed muscle weakness, spasm, frequent urination and ataxia of both lower limbs. The sequencing results showed that the CYP7B1 gene c.1171G>T (paternal) and c.1249C>T (maternal) compound heterozygous mutations were found in proband 1 and his younger brother. The CYP7B1 gene c.334C>T (paternal) and c.259+2T>C (maternal) compound heterozygous mutations were found in proband 2 and her younger sister. The CYP7B1 gene c.334C>T (paternal) and c.1082G>A (maternal) compound heterozygous mutations were found in proband 3. And c.1171G>T was a new variant that had not been reported before. Dynamic mutation analysis showed that the numbers of CAG repeats of ATXN1/2/3/6/7/8/12, DRPLA, TBP genes were within the normal range. According to the clinical manifestations and genetic examination results of the children in the 3 pedigrees, the diagnosis of HSP5 was clear. Conclusions:The 3 families in the study all had complex HSP5 caused by compound heterozygous mutations of the CYP7B1 gene. WES can analyze SNV, INDEL and dynamic mutations simultaneously to make the maximum clear diagnosis and can be used as an effective detection method for HSP5.
		                        		
		                        		
		                        		
		                        	
6.The intermediary effect of dyadic coping style in the relationship between psychological distress and intimate relationship in stroke patients
Xuan DU ; Nana LIANG ; Xiaohui LIU ; Xiaoling LIU ; Fang LIU ; Wenli NA ; Wenyu WANG ; Chunjing KANG ; Lingling YANG ; Ru GAN
Chinese Journal of Practical Nursing 2023;39(13):961-967
		                        		
		                        			
		                        			Objective:To explore the relationship between psychological distress and intimacy in stroke patients and the mediating effect of different dyadic coping style, to provide theoretical guidance for improving the intimate relationship of stroke patients.Methods:A convenient sampling method was used to select 203 patients with stroke who visited the General Hospital of Ningxia Medical University, the People's Hospital of Ningxia Hui Autonomous Region and the Department of Neurology of Yinchuan First People's Hospital from December 2020 to July 2021 as the survey objects. The general information questionnaire, Kessler Psychological Distress Scale, Quality of Relationship Index and Dyadic Coping Inventory were used to investigate patients.Results:The scores of psychological distress, intimate relationship, positive dyadic coping and negative dyadic coping were 19.33 ± 7.46, 32.75 ± 6.79, 86.25 ± 13.22, and 16.46 ± 4.08, respectively. Correlation analysis showed that psychological distress was negatively correlated with intimate relationship and positive dyadic coping ( r=-0.195, -0.204, both P<0.01), psychological distress was positively correlated with negative dyadic coping ( r=0.229, P<0.01). The mediating effect of positive dyadic coping and negative dyadic coping on psychological distress and intimate relationship was 35.87% and 53.26%, respectively. Conclusions:The psychological distress indirectly affects the intimate relationship of stroke patients through positive dyadic coping and negative dyadic coping. Health care workers can guide patients to actively cope with the disease and encourage couples to strengthen communication, so as to enhance the intimacy of couples and promote their physical and mental health development.
		                        		
		                        		
		                        		
		                        	
7.Application of 20 MHz high-frequency ultrasound in scar evaluation
Lu BAI ; Xueqin SHI ; Li YANG ; Wenli ZHAO ; Na LI ; Juntao HAN ; Dahai HU
Chinese Journal of Plastic Surgery 2023;39(6):583-589
		                        		
		                        			
		                        			Objective:To investigate the role of 20 MHz high-frequency ultrasound in evaluating scar thickness and morphology.Methods:The clinical data of patients with the initial stage of scar formation after burn trauma (<1 month), hypertrophic scar (1-6 months) and atrophic scar (>6 months) treated by the Department of Burn and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University from April 2019 to December 2020, were retrospectively analyzed. All patients were evaluated by 20 MHz high-frequency ultrasound, histopathology and Vancouver scar scale (VSS). Three measurement points were randomly selected at the scar during ultrasonic examination, and the average value was recorded as the ultrasonic thickness measurement value. The scar tissue samples were collected from the site of ultrasonic examination, and HE staining and Masson staining were performed. At the same time, scar thickness was evaluated by two physicians using VSS. The difference of scar thickness assessment result among the 3 method in patients at the initial stage of scar formation, hypertrophic scar and atrophic scar was compared. Meanwhile, the relationship between the characteristics of 20 MHz high-frequency ultrasound and histopathology was compared. The measurement data of normal distribution were expressed as Mean±SD. One-way ANOVA was used for comparison among three groups, and SNK- q test was used for pairwise comparison between groups. Counting data were analyzed by Chi-square test. Results:A total of 224 patients were included, including 91 males and 133 females, aged from 1 to 34 years, with an average age of 25.7 years. There were 79 patients at the initial stage of scar formation, 102 at the hypertrophic stage, and 43 at the atrophic stage. (1) In the initial stage of scar formation, the thickness measured by 20 MHz ultrasound was about (2.01±0.68) mm, the thickness evaluated by VSS was (1.72±0.49) mm, and the thickness measured by pathological section was (2.11±0.45) mm. In the hyperplastic scar stage, the thickness measured by 20 MHz ultrasound was (4.11±0.73) mm, the thickness evaluated by VSS was (3.02±0.47) mm, and the thickness measured by pathological section was (4.27±0.44) mm. In the atrophic scar stage, the thickness measured by 20 MHz ultrasound was (1.74±0.64) mm, the thickness measured by VSS was (1.77±0.61) mm, and the thickness measured by pathological section was (1.71±0.67) mm. For scars in the above three periods, there was no statistical significance between scar thickness measured by 20 MHz high-frequency ultrasound and that measured by pathological sections(all P<0.05). In the initial stage of scar formation and hypertrophic stage, the thickness evaluated by VSS was significantly different from that measured by 20 MHz high-frequency ultrasound and pathology (all P<0.05), respectively. (2) Echo intensity was evaluated by ultrasound. In the initial stage of scar formation, the thickness of the epidermis shown by high-frequency ultrasound was close to that of the normal epidermis and presented a high-intensity echo, but there was a strip of echoless or no echo zone of <1 mm between the high-intensity echo epidermis and dermis, which looked like dermal edema. Pathology showed that there were acanthoid changes in the epidermis of the scar at this stage, rich capillaries and a small amount of collagen fibrous tissue in the dermis. In the hyperplastic scar stage, the scar epidermis still showed strong echo, while the dermis showed uneven echo, the superficial dermis showed obvious isoecho, and the deep dermis showed no echo or hypoecho. Pathology showed that the epidermis was thin and smooth, and keratosis was obvious. Collagen fibers parallel to the epidermis could be seen in the superficial layer of the dermis, with regular arrangement. Collagen fibers were increased and thickened in the deep layer of the dermis, in the shape of nodules and swirls. In the atrophic scar stage, the scar epidermis presented a strong echo, and there was no obvious demarcation between the dermis and subcutaneous tissue, presenting a uniform echo. Pathological findings showed that the epidermis became thinner with a "skin nails" -like structure, the junction between the superficial and deep dermis was not obvious, and the collagen fibers were arranged in parallel or oblique direction, and the surface boundary was unclear. Conclusion:20 MHz high-frequency ultrasound is more accurate than VSS in the assessment of thickness of hypertrophic scar, and can reflect the collagen content and moisture ratio in scar. Compared with pathological examination, it has the advantages of non-invasive and fast, and is an effective means to evaluate scar thickness and morphology.
		                        		
		                        		
		                        		
		                        	
8.Application of 20 MHz high-frequency ultrasound in scar evaluation
Lu BAI ; Xueqin SHI ; Li YANG ; Wenli ZHAO ; Na LI ; Juntao HAN ; Dahai HU
Chinese Journal of Plastic Surgery 2023;39(6):583-589
		                        		
		                        			
		                        			Objective:To investigate the role of 20 MHz high-frequency ultrasound in evaluating scar thickness and morphology.Methods:The clinical data of patients with the initial stage of scar formation after burn trauma (<1 month), hypertrophic scar (1-6 months) and atrophic scar (>6 months) treated by the Department of Burn and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University from April 2019 to December 2020, were retrospectively analyzed. All patients were evaluated by 20 MHz high-frequency ultrasound, histopathology and Vancouver scar scale (VSS). Three measurement points were randomly selected at the scar during ultrasonic examination, and the average value was recorded as the ultrasonic thickness measurement value. The scar tissue samples were collected from the site of ultrasonic examination, and HE staining and Masson staining were performed. At the same time, scar thickness was evaluated by two physicians using VSS. The difference of scar thickness assessment result among the 3 method in patients at the initial stage of scar formation, hypertrophic scar and atrophic scar was compared. Meanwhile, the relationship between the characteristics of 20 MHz high-frequency ultrasound and histopathology was compared. The measurement data of normal distribution were expressed as Mean±SD. One-way ANOVA was used for comparison among three groups, and SNK- q test was used for pairwise comparison between groups. Counting data were analyzed by Chi-square test. Results:A total of 224 patients were included, including 91 males and 133 females, aged from 1 to 34 years, with an average age of 25.7 years. There were 79 patients at the initial stage of scar formation, 102 at the hypertrophic stage, and 43 at the atrophic stage. (1) In the initial stage of scar formation, the thickness measured by 20 MHz ultrasound was about (2.01±0.68) mm, the thickness evaluated by VSS was (1.72±0.49) mm, and the thickness measured by pathological section was (2.11±0.45) mm. In the hyperplastic scar stage, the thickness measured by 20 MHz ultrasound was (4.11±0.73) mm, the thickness evaluated by VSS was (3.02±0.47) mm, and the thickness measured by pathological section was (4.27±0.44) mm. In the atrophic scar stage, the thickness measured by 20 MHz ultrasound was (1.74±0.64) mm, the thickness measured by VSS was (1.77±0.61) mm, and the thickness measured by pathological section was (1.71±0.67) mm. For scars in the above three periods, there was no statistical significance between scar thickness measured by 20 MHz high-frequency ultrasound and that measured by pathological sections(all P<0.05). In the initial stage of scar formation and hypertrophic stage, the thickness evaluated by VSS was significantly different from that measured by 20 MHz high-frequency ultrasound and pathology (all P<0.05), respectively. (2) Echo intensity was evaluated by ultrasound. In the initial stage of scar formation, the thickness of the epidermis shown by high-frequency ultrasound was close to that of the normal epidermis and presented a high-intensity echo, but there was a strip of echoless or no echo zone of <1 mm between the high-intensity echo epidermis and dermis, which looked like dermal edema. Pathology showed that there were acanthoid changes in the epidermis of the scar at this stage, rich capillaries and a small amount of collagen fibrous tissue in the dermis. In the hyperplastic scar stage, the scar epidermis still showed strong echo, while the dermis showed uneven echo, the superficial dermis showed obvious isoecho, and the deep dermis showed no echo or hypoecho. Pathology showed that the epidermis was thin and smooth, and keratosis was obvious. Collagen fibers parallel to the epidermis could be seen in the superficial layer of the dermis, with regular arrangement. Collagen fibers were increased and thickened in the deep layer of the dermis, in the shape of nodules and swirls. In the atrophic scar stage, the scar epidermis presented a strong echo, and there was no obvious demarcation between the dermis and subcutaneous tissue, presenting a uniform echo. Pathological findings showed that the epidermis became thinner with a "skin nails" -like structure, the junction between the superficial and deep dermis was not obvious, and the collagen fibers were arranged in parallel or oblique direction, and the surface boundary was unclear. Conclusion:20 MHz high-frequency ultrasound is more accurate than VSS in the assessment of thickness of hypertrophic scar, and can reflect the collagen content and moisture ratio in scar. Compared with pathological examination, it has the advantages of non-invasive and fast, and is an effective means to evaluate scar thickness and morphology.
		                        		
		                        		
		                        		
		                        	
9.Influence of perceived stress on fatigue of main caregivers of stroke patients: the chain intermediary effect of resourcefulness and social support
Xuan DU ; Lingling YANG ; Xiaohui LIU ; Fang LIU ; Wenli NA ; Xiaoling LIU ; Wenyu WANG ; Chunjing KANG ; Nana LIANG ; Ru GAN
Chinese Journal of Modern Nursing 2023;29(1):35-41
		                        		
		                        			
		                        			Objective:To explore the effect of perceived stress on fatigue and its mechanism, so as to provide theoretical support for relieving the fatigue of the main caregivers of stroke patients.Methods:From December 2020 to August 2021, 311 main caregivers of stroke patients hospitalized in the Department of Neurology of Class Ⅲ Grade A hospitals in Yinchuan were selected by convenient sampling. The caregivers were investigated with the General Information Questionnaire, Perceived Stress Scale, Resourcefulness Scale, Social Support Rating Scale and Fatigue Scale.Results:In this study, a total of 311 questionnaires were distributed, and 308 valid questionnaires were recovered, with an effective recovery rate of 99.04%. The total scores of perceived stress, fatigue, resourcefulness and social support of the main caregivers of stroke patients were (24.98±6.36) , (5.31±2.86) , (83.98±12.85) and (39.76±6.21) respectively. Perceived stress were negatively correlated with resourcefulness and social support ( r=-0.313, -0.274, P<0.01) , and positively correlated with fatigue ( r=0.261, P<0.01) . Fatigue were negatively correlated with resourcefulness and social support ( r=-0.305, -0.268; P<0.01) . There was a positive correlation between resourcefulness and social support ( r=0.210, P<0.01) . The results of intermediary test showed that the direct effect of perceived stress on fatigue was valid, and the respective intermediary effect of resourcefulness and social support between perceived stress and fatigue, and the chain intermediary effect of resourcefulness and social support were also valid, with the amount of intermediary effect being 26.92%, 15.38% and 3.85% respectively. Conclusions:The chain mediation between perceived stress and fatigue is established between the resourcefulness and social support of the main caregivers of stroke patients. In the future, the mental and physical pressure of stroke patients can be alleviated by improving the resourcefulness of their main caregivers and providing social support.
		                        		
		                        		
		                        		
		                        	
10.Interpretation on Dietary Guidelines for Chinese School aged Children(2022)
ZHANG Na, ZHU Wenli, ZHANG Man, MA Guansheng
Chinese Journal of School Health 2022;43(6):805-808
		                        		
		                        			Abstract
		                        			School aged children grow and develop rapidly, and adequate nutrition is the material basis for their normal intellectual and physical development. It is necessary to formulate the dietary guidelines for school aged children on the basis of the dietary guidelines for the general population, and revise in time according to the changes in the nutritional health status of school aged children. The revision of the dietary guidelines for school aged children is based on the content of Dietary Guidelines for Chinese School aged Children (2016). In addition, according to the revision principles and procedures of the Dietary Guidelines for Chinese Residents, as well as comprehensive consideration of the current prominent dietary and nutritional problems of school aged children in China, Dietary Guidelines for Chinese School aged Children (2022) is finally issued after evidence based researches, discussion and consultation. Dietary Guidelines for Chinese School aged Children (2022) highlights the improvement of nutritional literacy, the cultivation of healthy eating behaviors, the building of healthy food environment, as well as updating the recommendation concerning diet and active physical activity. Dietary pagodas for school aged children of different three ages including 6-10 years, 11-13 years and 14-17 years are added to the guideline. The Guideline provides practical references for parents, teachers, school health workers, medical staff in child health services and workers in centers for disease control and prevention.
		                        		
		                        		
		                        		
		                        	
            

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