Objective To explore the changes in cerebral blood flow caused by mandibular retrusion,as well as the impact and potential mechanisms on stroke recovery.Methods 6-week-old SD male rats were selected as experi-mental subjects.The metal cannula was bonded to the rat maxillary incisor for one week,forcing mandibular retru-sion(MR).Cerebral blood flow was detected by laser speckle imaging.Cognitive function was detected by the Morris water.Then,the stroke model was constructed in MR rats by using the middle cerebral artery occlusion(MCAO)method for one week.Meanwhile,metal cannulae were then removed in rats to restore the lower jaw's position(MCAO RO),serving as a positive control group.Consequently,rats were randomly divided into the fol-lowing groups:Sham groups,MCAO groups,MCAO MR groups,and MCAO RO groups.Neurological recovery was assessed through the modified neurological severity score(mNSS).The area of cerebral infarction was evalua-ted by using triphenyltetrazolium(TTC)staining.The changes in nerve cells were observed by using hematoxylin eosin(HE)staining.The protein expression level of vascular endothelial growth factor(VEGF)was detected by immunohistochemistry.The protein expression levels of platelet-endothelial cell adhesion molecule(CD31),sirtuin 6(SIRT6),and thioredoxin interaction protein(TXNIP)were detected by Western blot.The mRNA expression levels of SIRT6,TXNIP,and VEGF were determined by qRT-PCR.Microglia activation marker molecule 1(IBA-1)was detected by immunofluorescence.Resluts Because of mandibular retrusion,laser speckle showed de-creased cerebral blood flow,and the water maze showed decreased cognitive function.Compared to other groups,MCAO MR showed a larger ischemic area in TTC staining,while HE staining and neurological scoring showed poo-rer neurological function recovery.Western blot and qRT-PCR showed that the MCAO MR group inhibited the mR-NA and protein expression levels of SIRT6,upregulated the mRNA and protein expression levels of TXNIP,and in-creased the activation of microglia.Conclusion Mandibular retrusion reduces cerebral blood flow and alters cogni-tive function in rats.Mandibular retrusion inhibits recovery in stroke through the SIRT6/TXNIP axis.

【Objective】 To explore the risk factors of transfusion-related acute lung injury (TRALI). 【Methods】 The clinical symptoms, signs, imaging examinations, and laboratory test results of two patients with TRALI after blood transfusion were retrospectively analyzed, and human leukocyte antigen (HLA) genotyping of the patient and HLA antibodies typing of the plasma donors were performed. 【Results】 The clinical manifestations and laboratory parameters of two patients were consistent with those of TRALI after blood transfusion. After timely clinical respiratory support treatment, all patients were improved. Blood donors produced high titers of HLA-Ⅱ antibodies after pregnancy, including antibodies that specifically recognize the patient′s HLA antigen. 【Conclusion】 Two patients developed TRALI after platelet transfusion from a female blood donor, which was caused by HLA-Ⅱ antibodies.

Objective : This study aims to explore the general rules of profile⁃based forehead protrusion value and appearance in Anhui province, and the results will provide guidance for clinical orthodontic works on matching lateral forehead protrusion and the lower third of the face in the future. Methods : A total of 262 patients were included in this cross⁃sectional study. The materials for the study were the lateral cephalometric radiographs and standard 90⁃degree profile photographs taken from the subjects at the same time. The Frankfurt horizontal( FH) plane was used to calibrate the head position parallel to the ground. The samples were grouped according to genders, ages and dentoskeletal classifications. The measurement points of forehead protrusion in profile included hairline point and soft tissue nasion point. The point where the parallel line connecting two points was tangent to the forehead contour was defined as the most convex point. The value of forehead protrusion in profile was expressed by the distance between two parallel lines. The forehead morphology was studied by tracing the forehead on lateral photographs. P-values < 0. 05 were considered statistically significant. Results : The lateral forehead protrusion of female was larger than that of male, and the difference between male and female decreased gradually from children (P < 0. 001), adolescents (P < 0. 001) to adults. The shape of the forehead differed between the two sexes. Female forehead is round, protruding part in the middle, the overall appearance like an arc; Male forehead was more straight, the most convex point was generally located near the eyebrow arch. Conclusion Gender is an important factor influencing profile forehead protrusion and appearance. The difference between male and female forehead protrusion decreases with age. But the shape remains different.

Objective To explore the application value of treatment-related markers PD-L1, PD-L2, CD30, CD23, BCL-2, BCL-6, MUM1 and GATA3 in the diagnosis and prognostic evaluation of primary mediastinal B-cell lymphoma(PMBL). Methods A retrospective study was conducted on 34 patients diagnosed with PMBL, and 31 patients with DLBCL-NOS which was not primary in the mediastinum were taken as control group. The expressions of 8 proteins were detected by IHC staining. Results The median percentages of tumor cells with PD-L1, PD-L2 and CD30 expression in PMBL group were 70% (30%, 90%), 25% (0, 70%) and 17.5% (0, 60%) respectively, which were significantly higher than those in the DLBCL-NOS group (P < 0.05). The positive rates of CD30 and CD23 in PMBL group were 61.76% (21/34) and 76.47% (26/34) respectively, significantly different with those in the DLBCL-NOS group (P=0.000). The survival curve of PMBL patients with CD30 or BCL-6 expression showed a trend of poor prognosis, despite the P value was > 0.05. Conclusion The high expression levels of PD-L1, PD-L2 and CD30 in PMBL are helpful to accurately identify more patients who may respond to immune or targeted therapy. Immunohistochemical staining of PD-L1, PD-L2, CD30 and CD23 is helpful for the differential diagnosis of PMBL and DLBCL-NOS. As candidate prognostic indicators of PMBL, CD30 and BCL-6 should be further studied in a larger number of samples.

Objective:To evaluate the effects of oropharyngeal administration of colostrum on feeding intolerance in preterm infants.Methods:A total of 87 preterm infants from December 2016 to December 2017 in the Second Affiliated Hospital of Wenzhou Medical University were distributed to the study group(41 cases) and the control group(46 cases) by random digits table method. The study group got oropharyngeal administration of 0.4 ml of own mother’s colostrum three times a day for 5 days. The control group got sterile water. The research data included early gastric residual volumes(the first to fourteenth day), gastric residual times and feeding status.Results:The gastric residual volumes on the eighth day, the eleventh day, the twelfth day were 8.5(0, 18.25), 0(0, 13.50), 2.5(0, 5.00) ml in the control group and 0(0,9.00), 0(0,1.00), 0(0,2.50) ml in the study group, the differences were statistically significant ( t values were -2.001, -1.987, -2.061, all P<0.05). The gastric residual times on the eighth day, the eleventh day were 1.5(0, 4.0), 0(0, 2.0) times in the control group, and 0(0, 1.0), 0(0, 0.5) times in the study group, the differences were statistically significant ( t values were -1.984, -2.267, all P<0.05).The vomiting times on the tenth day, the twelfth day were 0(0, 1.0), 0(0, 1.0) times in the control group and 0(0, 0.0), 0(0, 0.0) times in the study group, the differences were statistically significant ( t values were -3.149, -2.098, P<0.01 or 0.05). The time reaching full enteral feeding was (17.45±10.44) d in the study group, and (21.62±5.52) d in the control group, the difference was statistically significant ( t value was -2.022, P<0.05). Conclusions:Oropharyngeal administration of colostrum can better the condition of feeding intolerance.

Objective: To investigate the impact of ultrasonic assisted rapid processing technique combined with the environment friendly reagent (which can be utilized in fixing,dehydrating and clearing) on processing tumor biopsy specimens and the subsequent target detection. Methods: Postoperative tissue samples of 56 cases of breast cancer, colorectal cancer, lung cancer, stomach cancer, liver mass, bladder mass, uterus mass were obtained at the National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences from February to April, 2017. Three specimens ranging in size from 1 to 3 mm were collected from each sample, and were separated into control group (traditional tissue-processing method); experiment group 1 (3.7% neutral buffered formaldehyde fixation, composite environment friendly reagent and ultrasonic assisted rapid processing) and experimental group 2 (composite environment friendly reagent direct fixation, higher temperature and longer time for tissue processing). Two pathologists blinded to the experimental groups scored totally the nuclear, cytoplasmic, and membrane staining of 43 cases of immunohistochemistry (IHC), four HER2 fluorescence in situ hybridization (FISH), 20 extracted DNA quality and four EGFR gene mutation detection in lung adenocarcinoma; the results were compared with the control group. Results: There was no difference in the IHC staining, HER2 FISH, the DNA quality, and EGFR genetic results between experimental group 1 and control group. For experiment group 2, comparing results of IHC staining, HER2 FISH and the quality of DNA, there was no obvious difference from control group and experiment group 1, but might show an increase in the background of IHC staining. The difference between the treatment temperature and time in the experimental group 2 did not affect the results of the gene mutation detection. Conclusions Environment freindly reagent and ultrasonic assisted rapid processing equipment could be used for rapid processing and diagnosis for tumor biopsies. Using complex environment-friendly reagents supplement fixation, higher treatment temperature and longer treatment time do not significantly affect the IHC, FISH and molecular detection accuracy.

Objective To explore the effect of application of task-based learning with experiential teaching on nursing clinical decision making ability. Methods A total of 96 nursing students were divided into experimental group and observation group with each of 48 nursing students. The experimental group used the application of task-based learning with experimental teaching, the control group used the traditional scenario simulation. At the end of the course, the final scores, skill operation scores and nursing students'evaluation of the course and clinical decision-making ability of nursing were observed in the two groups. Results The final scores, chapters related to task-based learning with experiential teaching, skill operation scores was (82.06±0.98), (12.01±0.88), (94.99±0.34) points in the experimental group, and (78.34±0.98), (9.32±0.76), (91.87±0.98) points in the control group, and the difference was significant(t=12.958, 9.872, 10.834, all P<0.01). The evaluation of teaching methods, teaching process and teaching effect was (20.06±0.98), (23.01±0.88), (35.99±0.34) points in the experimental group, and (17.34±0.98), (20.32±0.76), (30.87±0.98) points in the control group, and the difference was significant (t=5.96, 6.87, 6.99, all P<0.01).The score of clinical decision-making ability of nursing was (137.50 ± 12.61) points in the experimental group, and (123.88±9.89) points in the control group,and the difference was significant (t=5.891, P<0.01). Conclusions The effect of task-based learning with experiential teaching in teaching of nursing in vocational nursing students, enable students to transfer knowledge and experience in experience, it can improve the students' clinical decision making ability.

Objective To investigate the status quo of junior nurses' nursing work environment and clinical decision making perception,and to analyze the influence of nursing work environment on clinical decision making perception.Methods The general data questionnaire,nursing work environment scale and clinical decision making perception scale was used to investigate 633 Junior nurses in hospitals.Results The overall mean score of nursing work environment was (2.99±0.37) points,the dimensions score from high to low were:medical cooperation (3.12 ± 0.47) points,nursing management and leadership style (3.06 ± 0.47) points,nurse participation in hospital affairs (2.91 ±0.48) points,high quality nursing service (2.78 ± 0.48) points,sufficient manpower and material resources (2.75 ± 0.52) points,;clinical decision—making perception of Junior nurses was (143.36 ± 14.01) points,the dimensions score from high to low were:the decision—evaluative feedback (37.31 ± 4.53) points,determine the goal of solving the problem (36.16 ± 4.39) points,find the information again (35.04 ± 3.76) points,gather information ability (30.98 ± 3.80) points.The Total score of nursing work environment were positively correlated with the clinical decision making perception of junior nurses(r =0.08-0.28,P＜ 0.01).Conclusions Junior nurse's nursing work environment remains to be improved,nursing work environment has a good effect on clinical decision making perception,therefore,nursing managers should create a positive working atmosphere.It is beneficial to improve the awareness of nursing clinical decision-making by giving specific support to the needs of junior nurses.

Objective To explore the effect of four-element teaching design model based on comprehensive learning in teaching of basic nursing in vocational nursing students. Methods Ninety-six nursing students at Taizhou Vocational and Technical College in Zhejiang Province were selected as the study subjects. Ninety-six nursing students were divided into the experimental group and the control group with 48 nursing students in each. The experimental group used four-element teaching design model for teaching, and the control group adopted traditional teaching methods.The testing results and evaluation of nursing students for this curriculum were compared. Results The theoretical assessment and skill assessment of nursing students in the experimental group were 82.09±8.05 and 90.65±4.93 respectively, and in the control group were 76.30±10.20, 85.33±6.01. The difference was statistically significant (t =3.06,4.74, P<0.01). The scores of curriculum setting, teaching methods, assessment methods, and teaching effects in the experimental group were evaluated as 35.08±3.64, 42.06±4.75, 18.15±1.60, 40.35±6.20, in the control group were 29.63 ± 4.65, 36.02 ± 6.20, 14.04 ± 2.69, 36.35 ± 6.56. The difference was statistically significant (t=3.07-9.09, P<0.01). Conclusion The four-element teaching design model based on comprehensive learning can improve the students′ learning initiative and teaching effect of basic nursing, promote the coordinated development of nursing students'professional knowledge, skills and professional ability.

Objective To explore the feasibility of the promoting effect of ultrasound targeted microbubble destruction(UTMD) on establishment of type Ⅰ diabetic nephropathy in rats.Methods Forty male SD rats were randomly and equally divided into four groups(n =10):control group(group A),streptozocin group(group B),streptozocin and ultrasound microbubble group(group C) and streptozocin and UTMD group(group D).The fasting blood-glucose (FBG) were tested,the 24 h's urine were collected and the 24 h's urine mieroalbumin(mAlb) were measured and then urinary albumin excretion rate(UAER) were calculated twice a week at fixed time in all groups.When greater than 3-fold increase in UAER compared with controls at the same age and gender,the diabetic nephropathy model in rats was considered to be established successfully,then the change of time and weighed were recorded and rats were killed and collected the blood of left atrial appendage to measure,blood urea nitrogen (BUN),serum creatinine (SCr) and Alanine aminotransferase (ALT).The left kidneys were weighted and then observed glomerular pathological changes under light microscope and detected the expression of CD34 in kidney of rats in each group by immunohistochemical method.Results ①The time of establishing diabetic nephropathy model in group D was obviously shorter than that in group B and C (all P ＜ 0.05).The FBG,the kidney index,UAER,BUN and Scr values in group B,C and D were significantly higher than those in group A(all P ＜0.05),but ALT had no significant change among each groups(all P ＞0.05).②The pathological changes of diabetic nephropathy appeared in rats of group B,C and D;the expression of CD34 in B,C and D groups were raised.Conclusions UTMD can obviously shorten the molding time of type Ⅰ diabetic nephropathy rats,which has feasibility.