Objective    To propose a path planning method for precise robot-assisted bronchial intervention. Methods    In the MuJoCo dynamic simulation environment, a simulation model and a simulated bronchus model which could accurately represent the motion process of the robot were built. Based on the Informed RRT* algorithm, the known spatial information was used to improve the path planning method and the motion characteristics of the robot were simulated to verify the ability of the robot algorithm to reach the target position. Results    In the dynamic simulation environment, the robot could move as required, and could explore the target point of the planning task in a short time, and the position accuracy was improved by more than 50% compared with the existing electromagnetic navigation and other methods. Conclusion    The established simulation model can restore the motion of the robot, and the robot has the ability to move in the bronchial environment. The proposed method can precisely control the simulated robot to enter the more peripheral airway position. It has the advantages of accuracy and faster speed than traditional manual interventional surgery, and can be used for the human-machine coordinated control task of robot-assisted bronchoscopy.

Objective To establish a preliminary model which can effectively predict the risk for postoperative delirium (POD) in elderly orthopedic patients and verify its effectiveness.Methods This prospective study involved 2 cohorts.For an analysis cohort,the assessment data of 148 elderly orthopedic patients were collected who had been treated at Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University from June to October 2017.The relevant risk factors for POD (gender,age,BMI,schooling ＜ 9 years,history of smoking and alcohol drinking,concomitant diseases and perioperative factors) were screened after comparing POD and non-POD patients.All the risk factors were analyzed and a predictive model was established after valuation of independent risk factors.A predictive cohort of 66 patients was included according to the same inclusion and exclusion criteria as the analysis cohort out of the patients who had been treated at our hospital from November to December 2017.The 2 cohorts were scored by the predictive model to verify the validity of the model.Results A total of 18 risk factors were identified in this study.In the analysis cohort,age (P =0.006),schooling ＜ 9 years (P =0.043),cerebrovascular disease or mental illness (P =0.004),preoperative albumin (P =0.038) and intraoperative infusion of allogeneic blood (P =0.019) were risk factors for POD.Of them,age (P =0.037),schooling ＜ 9 years (P =0.003) and intraoperative infusion of allogeneic blood (P =0.042) were independent ones.In the predictive model,age ＞ 75 years was assigned 3 points,schooling ＜ 9 years 2 points and intraoperative infusion of allogeneic blood 5 points.The validity of the ROC curve was verified for the predictive model.According to the ROC curve,the analysis cohort had AUC =0.66 and the predictive cohort AUC =0.75,indicating a certain predictive value of the model.Conclusion Our predictive model can be used to effectively screen out those with a high risk for postoperative delirium from elderly orthopedic patients.

Objective: To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU). Methods: A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Q_max), maximum detrusor pressure during voiding phases (P_det.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded. Results: A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), P_det.max(23.95 cmH₂O vs. 30.01 cmH₂O, P=0.019), Q_max(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH₂O vs. 79.34 cmH₂O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days. Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.

Objective To investigate the association between DNA methylation of matrix metallo-proteinase 9(MMP-9) gene and cognitive function including continuous attention,cognitive flexibility and visuospatial memory in patients with chronic schizophrenia.Methods 71 male schizophrenia patients and 69 healthy controls were recruited and detected their cognitive function.Pyrosequencing was used to determine DNA methylation at CpG site in exon 4 and exon 5 of MMP-9 gene.RT-qPCR was used to detect MMP-9 gene expression.Clinical symptoms were assessed by BPRS.Results (1) Cognitive function including Trail Making Test A,Trail Making Test B,Stroop words only,Stroop colors only,Stroop interference,Spatial Processing Block design and Block Design all scores were significantly lower in schizophrenia patients with schizophrenia than those in health controls (P＜0.01);(2) The MMP-9 gene expression in PBMCs was significantly higher in schizophrenia patients (1.31± 0.48) than that in health control (1.11 ± 0.45,P＜ 0.05).The DNA methylation of CpG4-1,CpG4-2,CpG4-3,CpG4-4,CpG4-5,CpG5-1,CpG5-2,CpG5-4 of MMP-9 gene in schizophrenia patients were lower than those in health controls (P＜0.01).(3)DNA methylation of CpG4-3 was positive correlated with Stroop interference (r=0.324,P＜0.01) in health controls.Correlation analysis showed that DNA methylation of CpG4-1 was negatively correlated with sustained attention function (r =-0.329,P＜0.01),cognitive flexibility (r =-0.337,P＜ 0.01) and visuospatial memory (r =-0.308,P＜ 0.05) in schizophrenia patients.There were positive correlations between DNA methylation of CpG4-5 (r=0.305,P＜0.05),CpG5-1 (r=0.262,P＜0.05),CpG5-3 (r=0.260,P＜0.05),average DNA methylation at exon 5 (r=0.288,P＜0.05) and visuospatial memory.DNA methylation of CpG5-4 was positive correlated with sustained attention function (r=0.251,P＜0.05) and visuospatial memory (r=0.350,P＜ 0.01) respectively.Conclusion Male patients with schizophrenia suffer from extensive cognitive impairment,and methylation of MMP-9 gene may be associated with cognitive impairment of schizophrenia.

Objective To investigate the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation on neuron apoptosis,brain edema,activation of microglia,inflammatory response and neural function after traumatic brain injury (TBI) in rats,so as to understand the protection of ω-3 PUFA in rats following TBI and its mechanism.Methods TBI model was established using Feeney's method.Ninety SD rats were randomly divided into 5 groups:sham operation group (sham group),TBI group,TBI + selective activator of c-Jun N-terminal kinase (JNK) anisomycin group (TBI + Aniso group),TBI + ω-3 PUFA supplementation group (TBI + ω-3 group),and TBI + ω-3 PUFA supplementation + JNK activation group (TBI + ω-3 + Aniso group).We measured rat behavioral outcomes by modified neurological severity score (mNSS) on day 1,3,and 7 after TBI.Brain water content was measured with wet-dry weight method.The neuron apoptosis and microglial activation (identified by specific marker IBA-1) in TBI cerebral cortex were determined by TUNEL staining and immunofluorescence.Inflammatory cytokines [tumor necrosis factor-α (TNF-α),interleukin (IL)-1α,IL-1β,and IL-6] and the JNK signaling pathway (JNK,pJNK) were tested with reverse transcription-polymerase chain reaction and Western blot,respectively.Results Compared with the sham group,the levels of brain cell apoptosis,brain edema,neuron apoptosis,and inflammatory-relatived factors (TNF-α,IL-1 α,IL-1β,and IL-6) were significantly increased in the other four groups (P ＜ 0.05).Compared with the TBl group,ω-3 PUFA supplementation reduced brain water content following TBI,especially on day 3 after TBI [(78.14 ± 0.57) ％ vs.(82.31 ± 0.81) ％,P ＜ 0.01],and improved neurological function score (P ＜ 0.05).Meanwhile,ω-3 PUFA supplementation suppressed neuron apoptosis,the activation of microglia,and the mRNA and protein expressions of inflammatory cytokines (TNF-α,IL-1α,IL-1 β,IL-6).The activation of JNK signaling pathway was also inhibited by ω-3 PUFA.Conclusion ω-3 PUFA supplementation may markedly reduce brain edema,suppress neuron apoptosis,and improve neurological outcomes after TBI in rats,possibly mediated by inhibiting JNK signaling pathway and microglial activation,reducing microglia-induced cerebral inflammatory responses,demonstrated as down-regulated expression of TNF-α,IL-1α,IL-1β,and IL-6.

Objective To investigate the effect of autophagy response on neurological functions and the role of mitogen-activated protein kinases (MAPKs) signaling pathway in rats after traumatic brain injury (TBI).Methods Fifty-four healthy male SD rats were randomly divided into sham-operated group,TBI group and TBI+autophagy inhibitor 3-methyladenine (3-MA) group (n=18).TBI animal models of the later two groups were established using Feeney's method.Rats in the sham-operated group were only performed bone window opening without knock;rats in the TBI+3-MA group were given intraperitoneal injection of 3-MA(5 mg/kg) 30 min after modeling and rats in the other two groups were given the same volume of normal saline.Three and 7 d after modeling,the protein levels of S100B and neuron specific enolase (NSE) in serum were tested with enzyme linked immunosorbent assay (ELISA);modified neurologic severity scale (mNSS) was used to detect the movement,sense and reflex functions;brain water content was measured with wet-dry weight method.The autophagy related factors (LC3-Ⅱ and Beclin-1) and MAPKs signaling pathway related factors (c-Jun N-terminal kinase [JNK],phosphorylated [p]-JNK,extracellular signal-regulated kinase [ERK]1/2,p-ERK1/2,p38MAPK and p-p38MAPK) protein expressions in TBI cerebral cortex were determined by Western blotting.Results As compared with those in the sham-operated group,the brain edema level,mNSS scores,and S100B and NSE protein levels in the TBI group and TBI+3-MA group were significantly increased (P＜0.05);TBI+3-MA group had significantly lower brain edema level,mNSS scores,and S100B and NSE protein levels than TBI group (P＜0.05).The expression levels of autophagy and MAPKs signaling pathway related factors in the TBI group and TBI+3-MA group were significantly higher as compared with those in the sham-operated group (P＜0.05).As compared with the TBI group,TBI+3-MA group had significantly decreased levels of LC3-Ⅱ,Beclin-1 and activation of JNK and p-p38MAPK signaling pathways (P＜0.05).Conclusion Suppressing autophagy response markedly improves neurological outcomes after TBI,possibly mediated by inhibiting activation of JNK and p38MAPK signaling pathways.

Objective To study the change of audiological characteristics of neonate with severe hyperbilirubi‐nemia need to be exchanged transfusion ,and to explore the correlation between the peak concentrations of serum to‐tal bilirubin and hearing loss .Methods A total of 130 cases of neonate diagnosed with severe hyperbilirubinemia need to be exchanged transfusion were included in this study .Hearing tests of auditory brainstem response (ABR) , distortion product otoacoustic emission (DPOAE) and acoustic immittance were administered to these neonates and they were followed up three months old .They were divided into the normal group ,the mild - moderate group and the severe - extreme group according to the hearing tests results of three months .The peak concentrations of ser‐um total bilirubin and hearing condition among the three groups were analyzed .Results There were 85 neonates with normal hearing (65 .38% ,85/130) ,45 with hearing loss (33 .85% ,45/130 .For 88 ears ,there were 2 cases of single ear and 43 cases of both ears) ,including 11 cases of mild - moderate group (22 ears ,24 .44% ,11/45) and 34 cases with severe - extreme group (66 ears ,75 .56% ,34/45) .There were 16 neonates (32 ears) met the crite‐rion of auditory neuropathy (12 .31% ,16/130) .The difference of the peak concentrations of serum total bilirubin a‐mong the three groups was statistically significant (F=16 .525 ,P=16 .525) .And positive correlation was observed between ABR threshold and peak serum total bilirubin concentration (r=0 .584 ,P<0 .001) .Conclusion The ma‐jor feature of the neonate with severe hyperbilirubinemia need to be exchanged transfusion was extremely severe sen‐sorineural hearing loss in both ears ;and the higher probability of serious hearing loss with the higher peak concen‐trations of serum total bilirubin .

Objective To share the analysis results of follow -up after treatment of hyperbilirubinemia hear-ing .Methods 573 cases of neonatal hyperbilirubinemia by jaundice intervention method was divided into exchange transfusion group (67 cases ,bilirubin concentration range of 344 .2~1 107 .2 μmol/L ,457 .9 μmol/L on average) and therapy group (506 cases ,bilirubin concentration in the range of 205 .2~ 572 .6 μmol/L ,average 285 .2 μmol/L) .The auditory brainstem response ,distortion product otoacoustic emission hearing detection and immittance method were used .The two groups of hearing loss were compared with 836 cases of normal controls .Results The observation group showed that hearing disorder morbidity rate was 3 .49% (20/573) ,for the control group ,the hearing loss morbidity rate was 0 .24% (2/836) .There was a statistically significant difference between the two groups (P<0 .05) .For the exchange transfusion group ,hearing losses accounted for 25 .37% of the overall change (17/67) .For the phototherapy group ,the hearing losses accounted for 0 .59% of the overall (3/506) phototherapy , showing statistically significant difference between the two groups (P<0 .05) .There were hearing impairment with bilateral severe (80% ,16/20) and retrocochlear lesions (65% ,13/20) .Conclusion The bilirubin concentration in blood transfusion for the children tended to have hearing impairment ,more in bilateral severe and retrocochlear le-sions ,hearing loss was irreversible .

Objective:To explore the methods and the role of clinical pharmacists in the medical advice audit. Methods: The questionnaire was designed to analyze the results of the medical advice investigated by the clinical pharmacists from November 2011 to October 2012. Results:Totally 3 232 patients were in the use of antimicrobial drugs in a investigation of 14 675 patients in 178 724 medical advices, accounting for 22. 0% of the total number of the investigation;the use of antimicrobial agents in patients with medical advices of antimicrobial were 5 387, accounting for 3. 0% of the total number of the investigation;597 errors were detected and inter-vened, accounting for 0. 33% of the total number of the investigation;the main errors were dose errors, usage errors and repeated med-ication errors. Indication error and interaction error were more in the critically ill patients monitored by the clinical pharmacists than that in the general ward patients. Conclusion:Clinical pharmacists and ward pharmacists to participate medical advice review, partic-ularly to concern about the patients with medical advices of antimicrobial drugs, and to intervene reasonably in the dose errors, usage errors and repeated medication errors can improve the overall quality of the hospital pharmacist team, make sustainable development of rational use of drugs and reduce the risk of medication.

Objective To develop the suitable for our country , high reliability and validity of cognitive questionnaire about blood pressure monitoring in critical care nurses ( CCNs ) in order to provide the help for understanding the status of blood pressure monitoring in CCNs in our country .Methods The original entry pool was preliminarily established according the international assessment scale of clinical outcome in patients through the structured decision-making including the McGhee-items, references from databases and experts ’ modification.70 CCNs and 120 undergraduate nursing students with one ICU at least were surveyed by the preliminary questionnaire .The entries were screened again through the investigation of entry distribution , dispersion, t test, resolution coefficient and the discussion in core group again , and the reliability and validity of internal consistency were evaluated .Results The original entry pool was 35 items, and the items of experts ’ modification was 3;5 items were deleted through the item selection combined with the discussion in core group . The items of the remaining entries in three dimensions including the physiology of blood pressure monitoring , technical aspects of monitoring , wave distinguish and data interpretation were respectively 12, 8, 10 items.The total Cronbach ’ s αcoefficient of questionnaire was 0.783, and the Cronbach ’ s αcoefficient of different dimensions were respectively 0.822, 0.793 and 0.734.Six extracting factors explained 82.57% of the total variance, and the loads of the corresponding dimensions were more than 0.55.Conclusions The initial questionnaire which is consisted of items after selection can comprehensively reflect the connotation of blood pressure monitoring , and can be used for investigating the cognitive level of blood pressure monitoring in CCNs in our country due to high validity and reliability .