Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To investigate the effects of different surgical approaches on the efficacy and safety of patients with primary central nervous system lymphoma(PCNSL).Methods:The clinical data of 130 PCNSL patients admitted to The First Affiliated Hospital of University of Science and Tecnology of China between July 2012 and May 2023 were retrospectively analyzed.Patients were assigned into resection and biopsy groups according to the surgical approach.The safety and efficacy of the two groups were compared,including the objective re-sponse rate(ORR),overall survival(OS),and progression-free survival(PFS)after chemotherapy.Results:ORR and 2-year OS and PFS rates of the resection group were not significantly different from those of the biopsy group(ORR:63.2%vs.62.8%;2-year OS rate:68.6%vs.73.7%;2-year PFS rate:35.2%vs.40.7%,all P>0.05).The incidence of postoperative complications was significantly higher in the resection group than in the biopsy group(29.3%vs.11.4%,P=0.04).The difference in the length of hospitalization between the two groups was not statistic-ally significant.Treatment of the biopsy group was less expensive(P<0.01).Conclusions:In patients with PCNSL,biopsy and resection had comparable efficacy;however,the safety profile was better,and hospitalization was less costly in biopsy than in resection.

Objective To grasp the main environmental factors affecting the growth of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao;To predict the distribution of suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province;To provide references for the rational distribution of the resources in Shanxi Province.Methods This study utilized the sample point longitude and latitude information collected in the"Fourth Survey of Chinese Materia Medica Resources"database in Shanxi Province.The data were supplemented by searching the China Digital Herbarium and retrieving related literature records.347 sample points distribution data and environmental factors were added to the MaxEnt model.The main environmental factors and contribution rates affecting the geographical distribution of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao were screened out.The ArcGIS software was used to divide the ecological suitable area of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province.Results The area under the ROC curve of the established MaxEnt model was 0.909,indicating that the model prediction results were accurate.The model screened 19 environmental factors.Among them,climate factor was the most important environmental factor,followed by biological factor and topographic factor,and soil factor had the least influence.The potential suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province were mainly distributed in the northern mountainous areas,presenting a trend of gradually decreasing suitability levels from north to south.Under the current climate conditions,the most suitable area for Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province was 15 424 km2,the suitable area was 19 856 km2,the sub suitable area was 59 436 km2,and the unsuitable area was 61 894 km2.Conclusion Based on MaxEnt model and ArcGIS software,this study predicts the distribution of suitable areas of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao in Shanxi Province,which has certain reference value for the protection and rational distribution of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao resources in Shanxi Province.

Background N-nitrosamines, a group of by-products of drinking water disinfection, have strong cytotoxicity to mammals. N-nitrosamines in drinking water are at the ng·L⁻¹ level, and its accurate qualitative and quantitative analysis is difficult, so it is necessary to develop a sensitive and accurate method to determine N-nitrosamines in drinking water. Objective To establish a solid phase extraction-gas chromatography tandem mass spectrometry (GC-MS/MS) method for simultaneous determination of 10 kinds of N-nitrosamines in drinking water. To apply the established method to determine the levels of 10 kinds of N-nitrosamines in drinking water in Nanjing, and to understand the pollution status. Methods Coconut charcoal solid phase extraction (SPE) cartridge and HLB Pro SPE cartridge were compared for the extraction efficiency of 10 N-nitrosamines in drinking water. A coconut charcoal SPE cartridge and a HLB Pro SPE cartridge were concatenated using a SPE connector, and then formed two combinations: coconut charcoal (top)-HLB Pro (bottom) and HLB Pro (top)-coconut charcoal (bottom), to extract the spiked samples, and combined with direct and independent elution ways to obtain the best extraction efficiency. From November to December 2021, 9 raw water, 10 finished water, and 7 tap water samples were collected from 9 municipal water supply units in Nanjing with 1 L brown glass sampling bottles. An 1.0 L drinking water sample was added with the isotope internal standard to prepare a test sample containing an isotope internal standard concentration of 25 ng·L⁻¹. The automatic SPE instrument loaded all the 1.0 L drinking water samples to the tandem SPE cartridge of the HLB Pro (top)-coconut charcoal (bottom) at the rate of 15 mL·min⁻¹. After extraction, the HLB Pro SPE cartridge and coconut charcoal SPE cartridge were transferred to the solid phase extraction vacuum device and eluted with 10 mL of dichloromethane respectively, then the dichloromethane eluents were combined, and concentrated to about 1.0 mL by nitrogen blowing after a small amount of the upper aqueous phase was removed. The concentrated solution was detected by GC-MS/MS and quantified by isotope internal standard method. Results The comparison of sample spike recovery experiments showed that coconut charcoal solid phase extraction (SPE) cartridge and HLB Pro SPE cartridge presented highcomplementarity for the extraction efficiency of 10 N-nitrosamines in drinking water. Using HLB Pro (top)-coconut charcoal (bottom), independent elution, and combined with eluents, the optimal extraction efficiency was obtained. Under these conditions, by GC MS/MS, the 10 N-nitrosamines showed a good linear relationship within the range of 2–50 ng·L⁻¹, the correlation coefficients were all greater than 0.9996, the method detection limit was 0.149–0.211 ng·L⁻¹, and the limit of quantification was 0.596–0.844 ng·L⁻¹. At the spiked concentrations of 5.0, 15, and 30 ng·L⁻¹, the average recoveries of the 10 kinds of N-nitrosamines were 88.0%–104.8%, and the relative standard deviations were 1.22%–4.87%. When applying the method to determine the concentrations of the 10 N-nitrosamines in Nanjing drinking water, the results showed that the 10 N-nitrosamines were positive in different degrees in raw water, finish water, and terminal water, the detection rates were 0%–100%, and the concentrations were ND–27.6 ng·L⁻¹. Conclusion This tandem solid phase extraction-gas chromatography tandem mass spectrometry method can achieve simultaneous determination of a variety of N-nitrosamines in drinking water with high sensitivity and high throughput.

Objective:To explore the current status and influencing factors of benefit findings in patients with lymphoma, so as to provide a reference for formulating intervention measures.Methods:Convenience sampling was used to select 110 lymphoma patients admitted to Shanxi Provincial Cancer Hospital from August 2021 to December 2021. The General Information Questionnaire, Benefit Finding Scale (BFS) , Social Support Rate Scale (SSRS) and Herth Hope Index were used to investigate them. Univariate analysis was performed using independent samples t-test and analysis of variance, and multivariate analysis was performed using multiple linear regression analysis. Results:The scores of benefit finding, social support and hope of lymphoma patients were (49.02±7.18) , (33.92±6.88) and (32.83±6.44) , respectively. The results of Pearson correlation showed that the benefit finding of lymphoma patients was positively correlated with the hope and social support ( P<0.001) , and the hope was positively correlated with social support ( P<0.001) . The results of multiple linear regression analysis showed that age, education, per capita monthly household income, hope and social support were the influencing factors of the benefit finding of lymphoma patients ( P<0.05) . Conclusions:The level of disease benefit finding in lymphoma patients is not high. Corresponding intervention should be taken according to the influencing factors of benefit finding to improve the benefit finding and quality of life of patients.

Objective:To explore the effect of intervention based on self-regulation theory on self-management behavior and coping styles of chronic obstructive pulmonary disease (COPD) patients.Methods:From January to June 2019, convenience sampling was used to select COPD patients hospitalized in Zhumadian Central Hospital as the research object. Patients were randomly divided into control group ( n=45) and experimental group ( n=48) . Control group conducted routine care and health education for COPD patients, and experimental group carried out an intervention program based on self-regulation theory on the basis of routine care. The intervention effect was evaluated with the Self-Management Scale for Chinese Patients with Chronic Obstructive Pulmonary Disease and the Simple Coping Style Scale. Results:After three months of intervention, the scores of symptom management, daily life management, emotion management, information management and self-efficacy of patients in experimental group were (31.74±3.62) , (46.17±5.48) , (39.55±4.49) , (23.65±4.21) , and (30.00±4.37) respectively, all higher than those in control group, the differencs were statistically significant ( t=5.829, 3.613, 3.208, 3.002, 2.762; P<0.01) . After intervention, the scores of positive coping styles of patients in experimental group and control group were (1.89±0.52) and (1.66±0.49) respectively with a statistical difference ( t=2.192, P<0.05) . Conclusions:Intervention program based on self-regulation theory can improve the self-management behavior of COPD patients, and encourage patients to adopt active coping styles to deal with the disease.

Objective:To explore the effects of exercise rehabilitation program for chronic obstructive pulmonary disease (COPD) patients based on health action process approach (HAPA) on exercise self-efficacy and psychological resilience in COPD patients.Methods:From January to August 2019, we selected 100 COPD inpatients from Zhumadian Central Hospital as the research objects by convenience sampling. A total of 50 patients hospitalized from January to April 2019 were in control group, and 50 patients hospitalized from May to August 2019 were in observation group. Control group carried out the COPD routine nursing, while observation group implemented the exercise rehabilitation program for COPD patients based on HAPA. The effect of intervention was evaluated with the Exercise Self-Efficacy Scale and the Connor-Davidson Resilience Scale (CD-RISC) .Results:In the end, there were 46 valid questionnaires in control group, and 47 valid questionnaires in observation group. The scores of exercise self-efficacy of patients in observation group and control group three months after discharge were (8.89±2.70) and (7.73±1.67) respectively with a statistical difference ( t=2.485, P=0.015) . Three months after discharge, scores of three dimensions of CD-RISC, namely hardiness, strength and optimism, of observation group were (35.55±6.16) , (23.79±4.88) and (11.25±2.72) respectively, and those of control group were (32.33±6.79) , (21.22±4.17) and (9.80±2.56) , and differences were statistically significant ( t=2.396, 2.728, 2.646; P<0.05) . Conclusions:HAPA-based exercise rehabilitation program for COPD patients has a positive significance for improving the patients' exercise self-efficacy and psychological resilience.

Combined training is a new training mode which combines the education of profes-sional degree of clinical medicine graduate and the resident standardization training. Xiangya hospital of Central South University has tried this kind of training mode since 2012. We draw lessons from the advanced training concept in America in combination with the practical situation of our hospital and have established theXiangya-Yalemodel of resident standardization training featuring with the Six Xiangya goals which areprofessional ethics, professional skills, patient safety, medical ethics, teamwork spirit, innovation and self-improvement, highlighting the project manager responsibility system, 360 degree examination and assess-ment, assessment of the OSCE, Mini-CEX evaluation. Through comparing and analyzing the midterm exami-nation scores between the combined training group and non-combined training group, we have found that the combined training group is significantly superior to non-combined training group on clinical skills. In addition, the questionnaire survey results show that most graduate students have positive attitude tocombined training. They believe it will be helpful for them to improve the ability of clinical skills, med-ical practice, doctor-patient communication skills and theoretical knowledge, and contributes to the future career development. Combined training is one major initiative deepening the reform of medical health system and medical education which greatly promotes the development of our country health enterprise, although there still exist some flaws including training teachers, content, implementation, management and evaluation.

Objective To study computer toxicity prediction technology and predict the acute toxicity of Chinese materia medica; To provide a new way and method for safety evaluation of traditional Chinese medicine. Methods First, Mold2 software (version 2.0.0) was used to calculate molecular descriptors of 7409 chemical components. After preliminary screening of molecular descriptors, quantitative structure-activity relationship (QSAR) models were built up with Random Forest (RF) for screening the optimum prediction model. From the 83 kinds of toxic Chinese materia medica in Chinese Pharmacopoeia (2010 edition), acute toxicity of 60 kinds of Chinese materia medica reported from monomer structure (1692 chemical components) were under prediction.Results Totally 7409 pieces of data were obtained. When the descriptors were 52, RF modeling accuracy and Kappa were the highest, 0.712 and 0.436 respectively. Compound clusters were divided into 3 types according to optimum molecule descriptors (52). The accuracy and Kappa of the optimum model for the first type of compounds were 0.666 and 0.476 respectively; the accuracy and Kappa of the optimum model for the second type of compounds were 0.804 and 0.381 respectively; the accuracy and Kappa of the optimum model for the third type of compounds were 0.709 and 0.373 respectively. It was predicted that 60 kinds of Chinese materia medica containing 0 violent toxic compound, 2 high toxic compounds, 172 medium toxic compounds and 1518 low toxic compound.Conclusion QSAR model for prediction study on acute toxicity of chemical components of Chinese mareria medica can provide references combination medication and experimental studies.

Objective To investigate the clinical effect of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in treating senile intertrochanteric fractures.Methods From February 2006 to December 2014,111 cases of senile intertrochanteric fractures treated with PFNA and DHS at our institution were retrospectively analyzed.Fifty-nine cases were treated with PFNA (average age 77.4 years);and fifty-two cases were treated with DHS (average age 76.1 years).The outcome measures collected for statistical analysis on following aspect:surgical time,blood loss in operation,blood transfused,rate of patients transfused,time to partial weight beating,hospital stay,healing time of fracture,orthopedic complications,reoperation rate and post-operation hip function.The Harris Hip Score was used for functional evaluation.Results One hundred and eleven patients were followed up for 10 to 24 months (average 17.2 months).There were no significant differences between two groups with regard to the functional outcome at 1 year,hospital stay,orthopedic complications and reoperation rate (P ＞ 0.05).There were significant differences between the PFNA group and DHS group with regard to the surgical time [(60.7 ±9.9)min vs (97.5 ± 20.5) min],the blood loss in operation [(169.2 ± 82.1) ml vs (428.8 ± 126.O) ml],per patient concentrated red blood cells transfused [(0.7 ± 0.9) U vs (1.2 ± 1.3) U],blood transfusion rate (35.6％ vs 55.8％) and time to partial weight bearing [(12.9 ± 10.3)d vs (47.0 ± 15.5)d] (P ＜0.01).Conclusions PFNA is an effective method for the treatment of senile intertrochanteric fracture with the advantages of simple operative procedure,minimally invasion,stable fixation and fewer complications.