Background Manganese is an essential trace element for the human body and maintains normal development of many organs including the brain. However, long-term exposure to a high manganese environment or excessive manganese intake will lead to manganese poisoning and result in neurological diseases, and currently no effective treatment plan is available. Objective To develop an animal model for subchronic manganese exposure and assess the impact of Dendrobium nobile Lindl. alkaloids (DNLA) on manganese associated behavioral and hippocampal effects in rats. Methods Fifty male SPF SD rats were randomly allocated into a control group (0.9% normal saline by intraperitoneal injection), two experimental groups [7.5 mg·kg⁻¹ (low) or 15 mg·kg⁻¹ (high) of MnCl₂·4H₂O by intraperitoneal injection], and two DNLA antagonistic groups [15 mg·kg⁻¹ MnCl₂·4H₂O by intraperitoneal injection then either 20 mg·kg⁻¹ (low) or 40 mg·kg⁻¹ (high) DNLA by oral administration]. All groups of rats were adminaistered 5 d per wek, once a day, for consecutive 13 weeks. Following modeling, neurobehavioral assessments were conducted using open field, Morris water maze, and Y maze. Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to measure manganese levels in the blood and brain tissues of the rats, and hematoxylin-eosin (HE) staining was employed to examine neuronal morphological changes in the hippocampal tissues of the rats. Results The neurobehavioral tests revealed that the manganese-exposed rats exhibited decreased total movement distance, prolonged central zone dwelling time, and reduced motor activity in the open field test, indicating tendencies toward depression and anxiety (P<0.05). In the Y-maze test, the mean exploration distance in the novel arm, the number of entries into the novel arm, and the time spent in the novel arm of the managanses-exposed rats were all reduced, while the latency period increased, suggesting impaired spatial exploration and learning-memory functions (P<0.05). In the Morris water maze navigation test, the escape latency was significantly longer in the manganese-exposed rats compared to the control group, and the number of platform crossings decreased in the spatial probe test, indicating a significant decline in spatial learning and memory (P<0.05). The ICP-MS analysis showed elevated manganese concentrations in the blood and hippocampus of the exposed rats (P<0.05), and the histopathological observation revealed hippocampal damage. Following the DNLA intervention, the manganese-exposed rats showed increased total movement distance and reduced central zone dwelling time in the open field test (P<0.05). In the Y-maze test, the mean exploration distance in the novel arm, the number of entries into the novel arm, and the time spent in the novel arm increased, while the latency period decreased, suggesting alleviation of anxiety and improved exploratory behavior (P<0.05). In the Morris water maze test, the escape latency gradually shortened, and both the number of platform crossings and the percentage of time spent in the target quadrant increased, indicating improved spatial learning and memory (P<0.05). Additionally, the manganese levels in the blood and hippocampus decreased (P<0.05), and the hippocampal pathological changes were partially restored. Conclusion DNLA demonstrates the ability to counteract multiple neurotoxic effects following the elevation of manganese levels in the blood and hippocampal tissues of rats induced by subchronic manganese exposure. Specifically, DNLA is shown to ameliorate the behavioral alterations observed in rats after manganese exposure, and mitigate the hippocampal damage in manganese-exposed rats.

Objective:To study the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism.Methods:260 patients with osteoporotic vertebral fracture treated in our hospital from Feb. 2018 to Feb. 2020 were selected for study. All patients were treated with kyphoplasty. The clinical curative effect, blood calcium, PINP, and β-CTX level changes were observed, postoperative recurrence was followed up. Clinical data of fracture patients were collected, risk factors of osteoporotic vertebral fractures in patients with postoperative recurrence of fracture were analyzed, receiver-operating characteristic curve was drawn to analyze the predictive value of blood calcium, PINP, andβ-CTX in postoperative recurrence of osteoporotic vertebral fracture.Results:The total clinical response rate was 95.77% (249/260) after treatment. After treatment, serum calcium, PINP, and β-CTX decreased with time, and the difference was significant ( P<0.05) . All patients were followed up for 6 months. There were 81 cases (31.15%) suffering postoperative fracture and 179 cases (68.85%) without fracture. According to univariate analysis, there were no statistically significant differences in age, sex, BMI, history of trauma, underlying disease, site of surgical vertebral body, segment of surgical vertebral body, correction angle of sagittal kyphosis, or amount of bone cement injection between the two groups ( P>0.05) . Long-term history of glucocorticoid use, preoperative fractured vertebra number, surgical vertebra number, blood calcium, PINP, β-CTX, fracture compression rate, vertebra height recovery rate, reinforced vertebra number, and bone cement leakage were correlated with postoperative recurrence of fracture in patients with osteoporotic vertebral fracture ( P<0.05) . Multivariate Logistic analysis showed that long-term history of glucocorticoid use, preoperative number of fractured vertebrae, surgical vertebra number, fracture compression rate, vertebral height recovery rate, enhanced vertebral body number, bone cement leakage, blood calcium, PINP, and β-CTX were all independent risk factors for postoperative recurrence of osteoporotic vertebral fracture ( P<0.05) . ROC curve results showed that AUC, 95%CI and truncation value were 0.820, 0.770-0.871 and 2.12mmol/L vs 0.915, 0.873-0.957 and 45.51 ng/mL vs 0.973, 0.957-0.988, and 463.29 for serum calcium, PINP, and β-CTX respectively in predicting the recurrence of osteoporotic vertebral fracture. Conclusion:Kyphoplasty has a significant effect on osteoporotic vertebral fracture, and it can effectively improve the serum calcium, PINP, and β-CTX, which have a certain monitoring value for postoperative recurrence of fracture.

Data of patients underwent thoracic surgeries were retrospectively collected in our center from November 2016 to January 2019.The last recorded tidal volume and driving pressure before two-lung ventilation were selected.Patents were classified into driving pressure increase group (>15 cmH 2O) and normal group.The baseline characteristics, parameters of pulmonary function, left one-lung ventilation and protective ventilation strategies were recorded.Logistic regression analysis was used to identify the risk factors for driving pressure increase, correlation analyses between predicted body weight and total lung capacity and between forced vital capacity and total lung capacity were performed.The Receiver Operating Characteristic (ROC) curve was used to analyze the accuracy of the ratio of tidal volume to corrected forced vital capacity in predicting driving pressure increase.Sixty-two patients were included in this study.Body mass index, left one-lung ventilation and the ratio of tidal volume to corrected forced vital capacity ratio were the risk factors for driving pressure increase ( P<0.05 or 0.01). Predicted body weight (correlation coefficient was 0.66, P<0.01) and forced vital capacity (correlation coefficient was 0.75, P<0.01)were both positively correlated with total lung capacity, but the two coefficients were statistically significant difference ( P<0.05). The area under the ROC curve of the ratio of tidal volume to corrected forced vital capacity in predicting driving pressure increase was 0.846 (95% CI 0.749-0.943) ( P<0.01), the diagnostic threshold was 0.312, the sensitivity and specificity of this threshold were 0.800 and 0.781 respectively, so the boundary of tidal volume during one-lung ventilation should be either forced vital capacity×0.149 for left one-long ventilation or forced vital capacity×0.163 for right one-lung ventilation.In conclusion, the ratio of tidal volume to corrected forced vital capacity has a higher predictive value for driving pressure increase during one-lung ventilation, and forced vital capacity can be used as a reference while calculating tidal volume.

Objective? To explore the experience of patients with mechanical ventilation in Intensive Care Uni(t ICU) during early ambulation, and explore the process of early ambulation from the perspectives of patients. Methods? Applying the interview method in qualitative research, in-depth interviews were conducted for 15 conscious patients with artificial airway for mechanical ventilation in ICU of Affiliated Hospital of Ji'ning Medical University from January of 2017 to December of 2018. Colaizzi's 7-step phenomenological data analysis method was used to analyze and sort out the data obtained and get the theme. Results? Six themes were summarized:patients worried about the high risk of early ambulation, discomfort caused by early ambulation, lack of correct understanding on the importance of early ambulation and its benefits, early termination of ambulation caused by unacceptable ambulation way, patients hope to be encouraged by medical staff, patients look forward to social support and economic assistance. Conclusions? Early ambulation is not a separate experience, but interwoven with the experience of mechanical ventilation in ICU. In the process of early ambulation, patients are eager to get more professional, safe and comprehensive care.

Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle (CPA) is rare. We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicat-ing progressive multifocal exophytic pontine glioblastoma. Three lesions were reported, of which two were initially presented, and one was developed 2 months later. One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA. The other two lesions were located and confined within the pons. Initial magnetic resonance imaging and positron emission tomography–computed tomography indicated low-grade glioma or inflammatory disease. However, 2 and 3 months later, subsequent magnetic resonance spectroscopy (MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS, indicating a high-grade glioma. Subtotal resection was performed for the CPA lesion. Histopathologic examination showed discrepant features of different parts of the CPA lesion. The patient received no further chemotherapy or radiotherapy and died 2 months after surgery. The multifocal and exophytic features of this case and the heterogeneous manifes-tations on neurological images were rare and confusing for both diagnosis and surgical decision-making. Our case report may contribute knowledge and helpful guidance for other medical doctors.

BACKGROUND:Dialysis membrane is the most important part of a dialyzer, which directly affects the therapeutic efficacy of hemodialysis.
OBJECTIVE:To study the permeability, adsorbability and biocompatibility of high- and low-flux hemodialysis membrane in maintenance hemodialysis process.
METHODS:Forty-six hemodialysis patients due to chronic renal failure were selected, including 24 males and 22 females, aged 26-78 years. These patients were randomized into two groups: FX8 and FX60 groups. Dialog+ dialyzer and bicarbonate dialysate (Braun, Germany) were used in the two groups, and polysulfone membranes FX8 and FX60 were respectively used in the two group. Al the patients received hemodialysis three times per week, 4 hours once. After 4 months of dialysis, blood levels of toxins and inflammatory cytokines were detected in the two groups.
RESULTS AND CONCLUSION:After dialysis, there were no differences in the blood urea nitrogen, serum creatinine, blood phosphorus levels between the two groups. The clearance rates of β2-microglobulin and parathyrin were significantly higher in the FX60 group than the FX8 group (P < 0.05); the plasma levels of albumin and hemoglobin were significantly higher in the FX60 group than the FX8 group (P < 0.05); but the serum levels of interleukin-8 and tumor necrosis factor-a were lower in the FX60 group than the FX8 group (P < 0.05). These findings indicate that high-flux polysulfone membrane FX60 is superior to low-flux polysulfone membrane FX8 in the clearance of macromolecule toxins and biocompatibility.

Objective:To explore the effect and mechanism of intracellular Zn2+ concentration ([Zn2+ ]i) in hypoxia‐induced regulation of metalloproteinases (MMPs) and extracellular matrix (ECM) expression in nucleus pulposus (NP) cells .Methods:NP cells from SD rats received plate culture at first and then three‐dimensional culture with sodium alginate gel .[Zn2+ ]i was assayed by FluoZin‐3 AM staining .Proteoglycan was assayed by Alcian blue staining .Glycosaminoglycan was detected by 1 ,9‐dimethylmethylene blue (DMMB) assay .And real‐time PCR were used to assay the mRNA expression of α1 type II collagen (COL2A1) ,matrix metalloproteinase 13 (MMP‐13) and a disintegrin and metalloproteinase with a thrombospondin motif 5 (ADAMTS‐5) .The expression of ZRT ,IRT‐like protein 8(ZIP8) was assayed by immunohistochemistry and Western blotting .Results:Interleukin (IL)‐1βand ZnCl2 could significantly increase the [Zn2+ ]i of NP cells ,however ,the effect could be inhibited by hypoxia .Hypoxia did significantly attenuate the decrease of proteoglycan ,glycosaminoglycan ,and COL2A1 mRNA ,which was induced by IL‐1βand ZnCl2 treatment ,in sodium alginate three‐dimensional culture . However ,ZnCl2 inhibited the protective effect of hypoxia .Both an intracellular Zn2+chelator and hypoxia could inhibit the increase of MMP‐13 mRNA expression .IL‐1βand ZnCl2 treatment promoted the increase of ZIP8 expression in NP cells ,however ,hypoxia inhibited ZIP8 expression .Conclusions:Hypoxia may regulate the Zn2+ influx in NP cells . Zn2+ mediates the regulation effect of hypoxia on ECM and MMP‐13 .Perhaps the changes of [Zn2+ ]i are involved in the process of intervertebral disc degeneration .

Chemotherapy completion rate can reflect the tolerance and compliance of patients to chemotherapy. Poor tolerance may result in delay or suspension of the comprehensive treatment plan, thus affect the efficacy of cancer treatment. Evaluating methods to improve the completion rate of chemotherapy and reduce the occurrence of delayed chemotherapy has gained increasing attention and is the significant area of study in the field of cancer treatment. Studies have shown that Chinese medicine combined with chemotherapy could improve the quality of life in patients with stage IIIB/IV non-small-cell lung cancer (NSCLC).

Objective To investigate the characteristics of attentional control between Wenchuan earthquake anxious and normal children. Methods Using Screening Child Anxiety Related Emotional Disorders (SCARED), 18 earthquake anxious children were chosen as participants and 18 normal children were chosen as control group. They were asked to perform a visual search task. Results ( 1 ) The judgment accuracy of earthquake anxious children was lower than normal children's significantly ( ( 0.95 ± 0.01 ), ( 0. 98 ± 0. 01 ), P ＜0.01 ). ( 2 ) The reaction time of earthquake anxious children was significantly longer than normal children' s ((1664.5 ± 78.5 ) ms, ( 1110.7 ± 78.5 ) ms, P ＜ 0. 01 ). ( 3 ) There was significantly faster performance in the valid condition than in the neutral( ( 1304.7 ± 61.3 ) ms, ( 1382. 3 ± 47.4 ) ms, P ＜ 0. 05 ) and invalid condition ( ((1304.7 ± 61.3 )ms, (1475.8 ± 71.5 )ms; P ＜ 0. 05 ), as well as faster performance in the neutral than in the invalid condition ((1382.3 ± 47.4) ms, ( 1475.8 ± 71.5 ) ms, P ＜ 0.05 ) in all children. Conclusion The performance of earthquake anxious children on top-down attentional control task is less than normal children. It indicates that anxious emotion which is brought by traumatic incidents like earthquake influents earthquake anxious children' s cognitive processing ability.

Objective To compare the ability of intentional forgetting to emotional words of post traumatic stress disorder(PTSD) children and normal children by item method after Wenchuan earthquake 18 months.Methods Twenty PTSD children who met with CCMD-3 and DSM-Ⅳ criteria and twenty control group children were investigated. Sixteen positive and sixteen negative words were adopted as materials. PTSD children accomplished the words learning, arithmetical operation and memory tests ( include free recall, words completion and words recognition) in orderly. Results ( 1 )The free recall accuracy of PTSD children to positive words was significant high than negative words( (0.32 ±0.11 ), (0.28 ±0.10), P＜0.05). The free recall accuracy of control group to positive words was significant high than negative words ( (0.37 ± 0.09 ), (0.34 ± 0.13 ), P＜ 0.05 ). ( 2 )The words completion accuracy of PTSD children to positive words was significant low than negative words( (0.38± 0.12 ), (0.49 ± 0.12 ), P ＜ 0.05 ). The words completion accuracy of control group to positive words was significant low than negative words ( (0.39 ± 0.15 ), (0.56 ± 0.14 ), P ＜ 0.01 ). ( 3 ) There was no difference of words recognition accuracy of PTSD children to positive and negative words ( ( 0.64 ± 0. 19 ), (0.63 ± 0. 16), P ＞0. 05). There was no difference of words recognition accuracy of control group to positive and negative words ((0.64 ± 0. 16), (0.65 ±0. 19), P ＞ 0. 05). Conclusion There is a significant intentional forgetting effect on emotional words in PTSD children and normal children, and this effect were influenced not only by selective rehearsal but also retrieval inhibition.