Interventions to address parenting stress among caregivers of children with chronic diseases: An umbrella review.

BACKGROUND: Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases. DATA SOURCES: Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022. METHODS: Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types. RESULTS: Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions. CONCLUSIONS: This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies. RELEVANCE TO CLINICAL PRACTICE: The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies. PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution does not apply to this study.

Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study.

BACKGROUND: The two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person's psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students. OBJECTIVE: The present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD. METHOD: A cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate. RESULTS: The incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (ß = 0.662, OR = 1.938, CI:1.07-3.694) and perceived stress (ß = 0.167, OR = 1.181, CI:1.076-1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (ß = 0.323,OR = 1.382,CI:1.211-1.577), negative coping style (ß = 0.693,OR = 2.000, CI:1.21-3.568), and perceived stress (ß = 0.135,OR = 1.145,CI:1.050-1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (ß = 1.028,OR = 2.794,CI:1.227-6.364), current place of residence (Other continents VS China) (ß = -1.413, OR = 0.243,CI:0.065-0.910), COVID-19 pandemic-related stress (ß = 0.371,OR = 1.450,CI:1.284-1.636), negative coping style (ß = 1.092,OR = 2.979,CI:1.706-5.203), and perceived stress (ß = 0.339,OR = 1.403,CI:1.289-1.527). CONCLUSION: Single anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students' CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students' mental health status.

Stressors in university life and anxiety symptoms among international students: a sequential mediation model.

BACKGROUND: Anxiety is a common mental health problem among university students, and identification of its risk or associated factors and revelation of the underlying mechanism will be useful for making proper intervention strategies. The aim of our study is to test the sequential mediation of self-efficacy and perceived stress in the association between stressors in university life and anxiety symptoms. METHODS: A cross-sectional study design was adopted and a sample of 512 international students from a medical university of China completed the survey with measurements of stressors in university life, self-efficacy, perceived stress and anxiety symptoms. RESULTS: We found that 28.71% of the international students had anxiety symptoms, and stressors in university life were positively associated with anxiety symptoms (ß = 0.23, t = 5.83, p < 0.01). Moreover, sequential mediating role of self-efficacy and perceived stress in the association between the stressors and anxiety symptoms was revealed. CONCLUSIONS: Our study provided a new perspective on how to maintain the mental health, which suggested that self-efficacy improvement and stress reduction strategies should be incorporated in the training programs to support students.

Reliability and validity of the Child Perception Questionnaire 8 ~ 10 (CPQ8~10) in China: an instrument for measuring oral health-related quality of life among 8-10-year-old children.

OBJECTIVES: Children aged 8-10 are in a critical stage of growth and development, facing complex and specific oral health problems. In China, there is no specific assessment questionnaire for this age group. The Child Perception Questionnare 8 ~ 10 (CPQ8~10) has been widely used in many countries, with good reliability and validity. This study aimed to translate the CPQ8~10 into Chinese and assess its reliability and validity, and ascertain its applicability for 8-10-year-old children in China. MATERIALS AND METHODS: Brislin's translation model was used in developing the Chinese version of CPQ8~10. Internal consistency, retest reliability, criterion validity, and confirmatory factor analysis were performed to evaluate the reliability and validity of the Chinese version of the CPQ8~10 among 494 8 ~ 10-year-old children in China. RESULTS: A Chinese version of the CPQ8~10, aligned with Chinese culture and social features, was developed. The criterion validity was 0.719 (P < 0.001). The item-level content validity index (I-CVI) and scale-level content validity index (S-CVI) for the Chinese version of the CPQ8~10 were 0.80 ~ 1.00 and 0.968, respectively. Factor analysis revealed a logical relationship among the items in the Chinese version of the CPQ8~10. The Cronbach's α coefficient, retest reliability, and Guttman split-half reliability coefficient for the Chinese version of the CPQ8~10 were 0.819, 0.830, and 0.849, respectively. CONCLUSIONS: The Chinese version of the CPQ8~10 exhibited a structure consistent with the original questionnaire, displaying good reliability and validity. This study facilitates the application of CPQ8~10 in China. CLINICAL RELEVANCE: The Chinese version of the CPQ8~10 is a brief and suitable tool to evaluate oral health-related quality of life of 8 ~ 10-year-old children.

Reliability and validity of the 15-item Chronic Oral Mucosal Disease Questionnaire in China: A short-form instrument to measure quality of life.

BACKGROUND: Chronic oral mucosal diseases have been a common problem, which affected individuals' health and social functions seriously. Although there has been a rigorous Chinese version of the Chronic Mucosal Diseases Questionnaire (COMDQ-26) to measure the quality of life of patients with chronic oral mucosal diseases, 26 items were so redundant to be a burden for patients. It was necessary to make a brief, practical, and easy-to-use tool in China. This study aimed to test the validity and reliability of the Chinese version of the short-form Chronic Mucosal Diseases Questionnaire (COMDQ-15). METHODS: A total of 165 respondents from a tertiary stomatological hospital were recruited in this study from July to December, 2020. Internal consistency, test-retest reliability, criterion validity, confirmatory factor analysis, and exploratory factor analysis were used to evaluate the reliability and validity of the Chinese version of Chronic Mucosal Diseases Questionnaire-15. RESULTS: The total Cronbach's α of 0.841 and subscale ranging from 0.736 to 0.965 revealed good internal consistency of the reliability. The intraclass correlation coefficients exceeded 0.80 indicated excellent test-retest reliability. Compared with the Oral Health Impact Profile-14, the criterion validity was 0.549. The confirmatory factor analysis results supported acceptable validity of the Chinese version of Chronic Mucosal Diseases Questionnaire-15, and the exploratory factor analysis demonstrated that the 15 items were classified into four domains, with a cumulative proportion of 71.52%. CONCLUSION: The Chinese version of Chronic Mucosal Diseases Questionnaire-15 is a brief and low-burden tool, and has been proved reliable and valid to assess the quality of life of patients with chronic oral mucosal diseases in China (the Chinese Clinical Trial Registry (no. ChiCTR2000031607).

Study of the Lithium Storage Mechanism of N-Doped Carbon-Modified Cu2 S Electrodes for Lithium-Ion Batteries.

Owing to their high specific capacity and abundant reserve, Cux S compounds are promising electrode materials for lithium-ion batteries (LIBs). Carbon compositing could stabilize the Cux S structure and repress capacity fading during the electrochemical cycling, but the corresponding Li+ storage mechanism and stabilization effect should be further clarified. In this study, nanoscale Cu2 S was synthesized by CuS co-precipitation and thermal reduction with polyelectrolytes. High-temperature synchrotron radiation diffraction was used to monitor the thermal reduction process. During the first cycle, the conversion mechanism upon lithium storage in the Cu2 S/carbon was elucidated by operando synchrotron radiation diffraction and in situ X-ray absorption spectroscopy. The N-doped carbon-composited Cu2 S (Cu2 S/C) exhibits an initial discharge capacity of 425 mAh g-1 at 0.1 A g-1 , with a higher, long-term capacity of 523 mAh g-1 at 0.1 A g-1 after 200 cycles; in contrast, the bare CuS electrode exhibits 123 mAh g-1 after 200 cycles. Multiple-scan cyclic voltammetry proves that extra Li+ storage can mainly be ascribed to the contribution of the capacitive storage.

Work engagement and associated factors among dental nurses in China.

BACKGROUND: Work engagement is affected by many factors. The level of work engagement among dental nurses is unknown. METHODS: A cross-sectional questionnaire survey was conducted among 215 dental nurses. The Utrecht Work Engagement Scale, Chinese Nurse Stressors Scale, Work-related Acceptance and Action Questionnaire, Multi-dimensional Scale of Perceived Social Support, and General Well-Being Schedule were applied to measure Chinese nurses' work engagement, job stress, psychological flexibility, perceived social support and subjective well-being, respectively. Univariate analysis was used to identify the relationships of work engagement with demographic and psychological characteristics. Hierarchical linear regression analysis was applied to test the variance in work engagement accounted for by factors related to work engagement in the univariate analysis. RESULTS: The level of work engagement among Chinese dental nurses was moderate or above. Work engagement was positively associated with perceived social support, psychological flexibility and subjective well-being but negatively correlated with job stress. The hierarchical regression analysis showed that age, job stress, psychological flexibility and subjective well-being were significantly correlated with work engagement, though perceived social support was not, all of those psychological variables together explained 34.7% of the variance in work engagement. CONCLUSIONS: Dental nurses in China had an acceptable level of work engagement in terms of vigour, dedication and absorption. Increased job stress resulted in lower work engagement. Nurses who had higher levels of perceived social support, psychological flexibility and subjective well-being also had higher work engagement. It is necessary to understand the job stress of nurses, strengthen nurses' social support, relieve nurses' job stress, improve nurses' psychological flexibility and subjective well-being, which will improve nurses' work engagement levels.

Prevalence and predictors of anxiety and depressive symptoms among patients diagnosed with oral cancer in China: a cross-sectional study.

BACKGROUND: Anxiety and depression are common mental health problems among patients with cancer. While many psychological variables have been proven to influence anxiety and depressive symptoms, the variables are not mutually exclusive and their integrated effects on patients with oral cancer are yet unknown. The present study aims to explore the prevalence of anxiety and depressive symptoms among patients with oral cancer, to find out key potentially predictive factors associated with anxiety and depressive symptoms. METHOD: A cross-sectional study was carried out for Chinese patients with oral cancer between May 2016 and October 2017 in two Grade-A Tertiary Hospitals in Shenyang, China. Two hundred thirty patients with oral cancer were interviewed with questionnaires on demographic variables, Zung Self-Rating Anxiety Scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), Herth Hope Index (HHI), Social Impact Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Perceived Stress Scale-10 (PSS-10), and General Perceived Self-efficacy Scale(GSE). Chi-square test, nonparametric test, t-test and logistic regression analyses were conducted where appropriate to explore predictive factors of anxiety symptoms and depressive symptoms. RESULTS: The prevalence of anxiety symptoms and depressive symptoms in the sample population was 36.96% (85/230) and 65.21% (150/230), respectively. Social isolation dimension of stigma (ß = 0.436, OR = 1.547, CI:1.211 ~ 1.975), optimism (ß = - 0.276, OR = 0.759, CI:0.624 ~ 0.922), and perceived stress (ß = 0.217, OR = 1.243, CI:1.092 ~ 1.414) were predictors of anxiety symptoms. Marriage (ß = 1.648, OR = 5.198, CI:1.427 ~ 18.924), positive readiness and expectancy dimension of hope (ß = - 0.505, OR = 0.604, CI:0.395 ~ 0.923), social isolation dimension of stigma (ß = 0.314, OR = 1.368, CI:1.054 ~ 1.776) and perceived stress (ß = 0.273, OR = 1.314, CI:1.134 ~ 1.524) were predictors of depressive symptoms among oral cancer patients. CONCLUSION: The prevalence of anxiety symptoms and depressive symptoms was high among oral cancer patients in China. The communal predictors of anxiety and depressive symptoms in patients with oral cancer were levels of perceived stress and social isolation of stigma. In addition, optimism was a predictor of anxiety symptoms and hope was a predictor of depressive symptoms. TRIAL REGISTRATION: 2015-16, registered 20 Dec 2015.

Resilience and associated factors among Chinese patients diagnosed with oral cancer.

BACKGROUND: Resilience has been linked to psychological adaptation to many challenging life events. The present study aims to explore the level of resilience in oral cancer patients and the key factors associated with resilience, and to evaluate the relationship between resilience and anxiety. METHODS: A multiple center cross-sectional study was carried out for Chinese patients with oral cancer between May 2016 and October 2017 in the Stomatology Hospital of China Medical University and Department of Stomatology, Shengjing Hospital of China Medical University. Two hundred and thirty oral cancer patients replied to the questionnaires on resilience, hope, perceived social support, optimism, perceived stress and anxiety which were measured with Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Perceived Stress Scale-10 (PSS-10) and Zung Self-Rating Anxiety Scale (SAS), respectively. Univariate one-way ANOVA/t-test, Pearson's r and hierarchical linear regression analysis were conducted to explore the influence factors of resilience and the relationship between resilience and anxiety. RESULTS: The level of resilience was 67.93 ± 12.65. Resilience was positively correlated with hope, optimism and perceived social support, and negatively correlated with perceived stress. Hierarchical linear regression analysis showed that hope (ß = 0.386, P < 0.01), optimism (ß = 0.190, P < 0.01) and education (ß = 0.175, P < 0.01) were positively associated with resilience. The three variables in combination could explain 48.9% of the total variance in resilience. Higher level of resilience was associated less anxiety symptoms (X2 = 39.216, p = 0.000); and there was linear trend between resilience level and anxiety level among patients with oral cancer (X2 = 35.624, p = 0.000). CONCLUSION: Patients with oral cancer in China had moderate level of resilience. Hope, optimism and education were positively and significantly associated with resilience, indicating that higher level of hope, optimism and education may improve resilience in oral cancer patients, which in turn may help alleviate anxiety symptoms in patients.

Examining the effects of urban agglomeration polders on flood events in Qinhuai River basin, China with HEC-HMS model.

The urban agglomeration polders type of flood control pattern is a general flood control pattern in the eastern plain area and some of the secondary river basins in China. A HEC-HMS model of Qinhuai River basin based on the flood control pattern was established for simulating basin runoff, examining the impact of urban agglomeration polders on flood events, and estimating the effects of urbanization on hydrological processes of the urban agglomeration polders in Qinhuai River basin. The results indicate that the urban agglomeration polders could increase the peak flow and flood volume. The smaller the scale of the flood, the more significant the influence of the polder was to the flood volume. The distribution of the city circle polder has no obvious impact on the flood volume, but has effect on the peak flow. The closer the polder is to basin output, the smaller the influence it has on peak flows. As the level of urbanization gradually improving of city circle polder, flood volumes and peak flows gradually increase compared to those with the current level of urbanization (the impervious rate was 20%). The potential change in flood volume and peak flow with increasing impervious rate shows a linear relationship.

Anxiety symptoms among Chinese nurses and the associated factors: a cross sectional study.

BACKGROUND: Nurses are an indispensable component of the work force in the health care system. However, many of them are known to work in a stressful environment which may affect their mental well-being; the situation could be worse in rapidly transforming societies such as China. The purpose of this study was to investigate anxiety symptoms and the associated factors in Chinese nurses working in public city hospitals. METHODS: A cross-sectional survey was performed for Chinese nurses in public city hospitals of Liaoning Province, northeast China. Seven hospitals in different areas of the province were randomly selected for the study. The Zung Self-Rating Anxiety Scale was used to measure anxiety symptoms. Effort-reward imbalance questionnaire and Job Content Questionnaire were used to assess the work stressors. Univariate analysis and stepwise multivariate logistic regression analysis were used to identify the factors associated with anxiety symptoms. RESULTS: All registered nurses in the seven city hospitals, totaling 1807 registered nurses were surveyed. Of the returned questionnaires, 1437 were valid (79.5%) for analysis. Utilizing the total raw score ≥ 40 as the cut-off point, the prevalence of anxiety symptoms in these nurses was 43.4%. Demographic factors (education, chronic disease and life event), lifestyle factors (regular meals and physical exercise), work conditions (hospital grade, job rank, monthly salary, nurse-patient relationships, job satisfaction and intention of leaving), job content (social support and decision latitude), effort-reward imbalance and overcommitment were all significantly related to the anxiety symptoms. Multivariate logistic regression analysis showed main factors associated with anxiety symptoms were lower job rank (OR 2.501), overcommitment (OR 2.018), chronic diseases (OR 1.541), worse nurse-patient relationship (OR 1.434), higher social support (OR 0.573), lower hospital grade (OR 0.629), taking regular meals (OR 0.719) and higher level of job satisfaction (OR 0.722). CONCLUSIONS: A large proportion of Chinese nurses working in public city hospitals had anxiety symptoms, which warrants immediate investigation and intervention from the hospital administrators. Meanwhile, results of the study suggest that proper counseling, promotion of healthy lifestyle behavior and improvements to the social environment in the work place may be helpful toward reducing or preventing the anxiety symptoms.

Depressive symptoms among Chinese nurses: prevalence and the associated factors.

AIM: This article is a report of exploration of depressive symptoms and the associated factors among Chinese nurses working at public city hospitals. BACKGROUND: Hospital nurses are known to work in psychologically and physically demanding work environment, which may lead to depressive symptoms. However, little research has been done to address this problem in Chinese nurses. METHODS: A cross-sectional survey was carried out in seven randomly selected city hospitals of Liaoning Province, northeast of China in 2009. Depressive symptoms of the nurses were measured with the Chinese version of the Center for Epidemiologic Studies Depression Scale. Job Content Questionnaire and the effort-reward imbalance, demographic features, life style and work conditions were measured as the related factors. RESULTS: A total of 1592 nurses participated in the study and the effective response rate was 79·5%. The prevalence of depressive symptoms among the nurses was 61·7% (n = 886), of whom 74·9% (n = 664) had mild depressive symptoms. Multivariate logistic regression analysis showed that lower job rank, higher over commitment, alcohol consumption, worse nurse-patient relationship and higher education background were positively associated with depressive symptoms, whereas supervisor support, taking regular meals, doing physical exercises, higher skill discretion and higher job satisfaction were negatively associated with depressive symptoms. CONCLUSION: More than half of the Chinese nurses had depressive symptoms. As depressive symptoms may adversely affect quality of life and quality of care, consultation for the nurses with healthy life styles, work stress coping techniques and advice to administrator to improve social aspects of the work environment might be helpful to reduce the depressive symptoms in nurses.

Interventions and strategies to improve social support for caregivers of children with chronic diseases: An umbrella review.

Background: Social support is an important approach to improve the psychosocial health status and promote positive coping for caregivers of children with chronic diseases. Such an approach can reduce parenting stress, help resolve parenting difficulties through the use of various social support relationships. Methods: We performed an umbrella review methodology using the method of examination, analysis and synthesis of systematic reviews. A PRISMA flow diagram was used to show the search process. The Joanna Briggs Institute was used to appraise the quality of papers and a narrative synthesis was undertaken. Relevant English and Chinese systematic reviews were searched in Embase, PubMed, Web of science, OVID, CNKI, CBM, Wan Fang and Cochrane Library databases, until November 2021, June 2022. Results: Out of 1,905 records, we included fourteen systematic reviews for a synthesis. Evidence to promote social support for caregivers of children with chronic diseases was identified from four key aspects: (i) Intervention content; (ii) Intervention forms; (iii) Intervention time; and (iv) Sources of support. Conclusions: The findings of this review suggest that a combination of differing interventions, especially for early family, including the content of parenting training or education, attitude building and resource provision, which can implement online is recommend. More interventional studies and quantitative evidence syntheses are still needed. Impact: Adequate social support is essential to promote the psychological wellbeing of caregivers of children with chronic diseases. In the early stage of children's diseases, integrating different content and forms of interventions for caregivers' families and actively helping caregivers to identify available support resources can improve social support. The findings from this review can be used to guide caregivers of children with chronic diseases and provide evidence for healthcare professionals and social workers to carry out relevant interventions.

Er-xian ameliorates myocardial ischemia-reperfusion injury in rats through RISK pathway involving estrogen receptors.

Curculigo orchioides (CUR) and Epimedium (EPI) are traditional Chinese medicines with estrogen-like biological activity, called Xianmao and Xianlingpi (Er-xian) in Chinese. However, whether Er-xian exerts protective effects on myocardial ischemia-reperfusion injury (MIRI) is unknown. This study aimed to investigate the cardioprotective effects of Er-xian preconditioning against MIRI and the underlying mechanisms. CUR or EPI was administered intragastrically to aged female rats as a monotherapy or combination therapy. 2 weeks later, a rat MIRI model was established. Myocardial infarction size, myocardial morphology, cTnT, cell apoptosis rate, intracellular calcium concentration, mitochondrial permeability transition pore (MPTP) opening and reperfusion injury salvage kinase (RISK) signaling pathway molecules were observed after the surgery. To evaluate the mechanisms of Er-xian, estrogen receptors antagonists ICI 182780 and G15 were used. In this study, Er-xian notably alleviated myocardial tissue damage, maintained mitochondrial morphology, reduced infarct size and cardiac markers, and increased sera levels of E2. Moreover, Er-xian inhibited calcium overload and mPTP opening, and decreased cardiomyocyte apoptosis. We found that the dual therapy of CUR and EPI elicited more noticeable results than CUR or EPI monotherapy. The significant protective effects of Er-xian on ischemia-reperfusion myocardium were attributed to the up-regulation of AKT, ERK1/2 and GSK-3ß phosphorylation levels. The cardioprotective effects of Er-xian were significantly reduced after estrogen receptor blockade, especially GPER30. These results indicate that Er-xian attenuates MIRI through RISK signaling pathway and estrogen receptors are the critical mediators.

Peoniflorin Preconditioning Protects Against Myocardial Ischemia/Reperfusion Injury Through Inhibiting Myocardial Apoptosis: RISK Pathway Involved.

Preconditioning with Peoniflorin, a component of traditional Chinese prescriptions, was proposed to be a potential strategy for cardioprotection against ischemia/reperfusion (I/R) injury. However, the cardioprotective effect of Peoniflorin preconditioning has not been thoroughly confirmed, and the underlying mechanism remains unclear. Here, we examined the cardioprotective effect and its mechanism of Peoniflorin preconditioning against myocardial I/R injury. Rats were subjected to 30 min of transient ischemia followed by 2 h of reperfusion with or without Peoniflorin (100 mg/kg) prior to reperfusion. Peoniflorin preconditioning significantly limited myocardial infarct size and reperfusion arrhythmias, as well as obviously attenuated the histomorphological and micromorphological damages induced by I/R injury. The reduced myocardial injury was also associated with the anti-apoptotic effect of Peoniflorin, as evidence by decreased TUNEL-positive cells, upregulation of BCL-2 expression, and downregulation of Bax and caspase-3 expression. In an effort to evaluate the mechanism responsible for the observed cardioprotective and anti-apoptotic effect, Western blot of phosphorylated protein was performed after 20 min of reperfusion. Results showed that Peoniflorin preconditioning activated both the Akt and ERK1/2 arm of the reperfusion injury salvage kinase (RISK) pathway. To further confirm this mechanism, the PI3K signaling inhibitor LY294002 and ERK1/2 signaling inhibitor PD98059 were administered in vivo. The cardioprotective and anti-apoptotic effects of Peoniflorin preconditioning were diminished but not abolished by pretreatment with LY294002 or PD98059. Taken together, these results indicate that Peoniflorin preconditioning protects the myocardial against I/R injury and inhibits myocardial apoptosis via the activation of the RISK pathway, highlighting the potential therapeutic effects of Peoniflorin on reducing myocardial I/R injury.

[Determination of cinnamic acid and glycyrrhizic acid in rat serum and its pharmacokinetics after oral administration of Dangguisini decoction].

OBJECTIVE: To mensurate concentrations and pharmacokinetics of cinnamic acid and glycyrrhizic acid in rats after oral adiministration Dangguisini decoction. METHODS: To Determine serum concentration of cinnamic acid and glycyrrhizic acid by High-Performance Liquid Chromatography and calculate its parameter of pharmacokinetics in rats after oral administration of Dangguisini decoction via 3P97 software. RESULTS: Parameters of Pharmacokinetics of cinnamic acid and glycyrrhizic acid were Cmax 9.2008 (mg/L), AUC 304.0734 (mg/L) x min and Cmax 51.1330(mg/L), AUC 21476.9688 (mg/L) x min respectively in rats after oral administration of Dangguisini decoction. CONCLUSION: Absorption of cinnamic acid is quick and its metabolize is quick too, but metabolism of glycyrrhizic acid is oppositely slow in rats after oral administration of Dangguisini decoction.

Relationships Between Cross-Cultural Adaption, Perceived Stress and Psychological Health Among International Undergraduate Students From a Medical University During the COVID-19 Pandemic: A Moderated Mediation Model.

International university students may be at greater risk for developing psychological problems due to the unique stressors in them, particularly during the COVID-19 pandemic. The purpose of present study is to propose and test a moderated mediation model that would illuminate the underlying relationships of cross-cultural adaption, perceived stress and psychological health as well as the moderating effect of optimism and resilience among international medical undergraduates in China during the COVID-19 pandemic. The study was conducted via a web-based survey in November 2020. Electronic informed consents were obtained from all participants. A total of 453 students including 233 males and 220 females aged 18 to 28 years with an average age of 22.09 (SD = 2.73) completed the questionnaires. Symptom Checklist 90, the measurement of cross-cultural adaption, the Perceived Stress Scale, the Life Orientation Test-Revised and the Resilience Scale were used for the survey. Results for the moderated mediation model testing revealed that cross-cultural adaption significantly and negatively associated with the Global Severity Index (GSI) of the Symptom Checklist 90 (ß = -0.24, P < 0.01), and perceived stress partially mediated the relationship. Optimism (ß = -0.29, P < 0.01) and confidence in COVID-19 control (ß = -0.19, P < 0.01) had direct negative effects on perceived stress. Furthermore, optimism and resilience negatively moderated the indirect effect of cross-cultural adaption on psychological health through perceived stress. Findings of this study suggest that university educators ought to promote or make use of programs that cope with stress and boost optimism and resilience in order to support students not only adapt well to a new culture, but also keep good psychological health during the period of COVID-19 pandemic.

Meta-analysis of arterial anastomosis techniques in head and neck free tissue transfer.

The present meta-analysis aimed to investigate the differences in the incidence of thrombosis and vascular compromise in arterial anastomosis between microvascular anastomotic devices and hand-sewn techniques during free tissue transfer in the head and neck. We searched for articles in PubMed/Medline, CNKI, WANFANG DATA, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science, from January 1, 1962 till April 1, 2020 that reported data of microvascular anastomosis during free tissue transfer in the head and neck. The incidence of arterial thrombosis or vascular compromise, or both was the primary outcome. The secondary outcome was anastomotic time. We also assessed the sensitivity and the risk of bias. This meta-analysis included 583 arterial anastomoses from six studies. The group using microvascular anastomotic devices tended to have an increased incidence of arterial thrombosis and vascular compromise (risk ratio (RR), 3.42; P = 0.38; 95% confidence interval (CI), 0.91-12.77). The hand-sewn technique took significantly longer to perform the anastomosis compared with that of the microvascular anastomotic devices (weighted mean difference, 15.26 min; P<0.01; 95% CI, 14.65-15.87). Microvascular anastomotic devices might increase the risk of arterial thrombosis and vascular compromise compared with the hand-sewn technique; however, further randomized controlled trials are needed to provide a more accurate estimate. The application of microvascular anastomotic devices will help to reduce anastomotic surgery time and achieve acceptable vessel opening, benefiting from the developments of arterial couplers and microsurgical techniques.

Prevalence and Predictors of Anxiety and Depressive Symptoms Among International Medical Students in China During COVID-19 Pandemic.

Background: The rapid spread of Coronavirus Disease-19 (COVID-19) infection has been the most important public health crisis across the globe since the end of 2019. Anxiety and depression are the most common mental health problems among people during the pandemic, and many studies have reported anxiety and depressive symptoms in college students. However, information on the mental health status of international medical students during this critical period of time has been scarce, which hinders the efforts in making proper policy or strategies to help these students. The present study aims to explore the prevalence of anxiety and depressive symptoms in international medical students in China and to find out the factors that have potential predictive value for anxiety and depressive symptoms. Method: A cross-sectional study was carried out for international medical students during November 2020 at China Medical University in Shenyang, China. Five hundred and nineteen international students were interviewed with questionnaires containing demographic variables, Stressors in school, Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), Perceived Stress Scale (PSS-10), the Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R) and Resilience Scale-14 (RS-14). Univariate logistic regression and stepwise multiple logistic regression analyses were conducted where appropriate to explore the predictive factors of anxiety symptoms and depressive symptoms. Results: The prevalence of anxiety symptoms and depressive symptoms in the sample population was 28.5% (148/519) and 31.6% (164/519), respectively. Stressors in school (ß = 0.176, OR = 1.192, CI: 1.102-1.289), negative coping style (ß = 0.639, OR = 1.894, CI: 1.287-2.788) and perceived stress (ß = 0.230, OR = 1.258, CI: 1.184-1.337) were found to be the predictors of anxiety symptoms among the international medical students; while gender (ß = -0.594, OR = 0.552, CI: 0.315-0.968), stay up late (ß = 0.828, OR = 2.288, CI: 1.182-4.431), current place of residence (ß = 1.082, OR = 2.951, CI: 1.256-6.931), stressors in the school (ß = 0.303, OR = 1.354, CI: 1.266-1.496), negative coping style (ß = 0.866, OR = 2.377, CI: 1.516-3.725), perceived stress (ß = 0.233, OR = 1.262, CI: 1.180-1.351) were found to be predictors of depressive symptoms. Conclusion: The prevalence of anxiety symptoms and depressive symptoms was moderate among international medical students in China. The communal predictors of anxiety and depressive symptoms were stressors in school, negative coping style and perceived stress; while demographic factors such as gender (male), stay up late at night and current place of residence were found associated with depressive symptoms. These results suggest that proper stress management and specific interventions are needed to help students maintain their mental health during the COVID-19 pandemic period.

Resilience and Related Factors: A Comparison of Fathers and Mothers of Patients With Cleft Lip and/or Palate in China.

Background: Resilience has become a hot spot in the field of positive psychology to study life-change events. However, there were little information on resilience among the fathers and mothers of patients with cleft lip and/or palate respectively. The present study aimed to explore and compare the level and potential influential factors associated with resilience among fathers/mothers of patients with cleft lip and/or palate in China. Method: A cross-sectional study was carried out between April 2019 and July 2020 among fathers/mothers of patients with cleft lip and/or palate in two cleft lip and/or palate treatment centers in China. Sixty Nine fathers and 179 mothers of patients with cleft lip and/or palate were interviewed with a questionnaire on demographic variables and the Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Parenting Stress Index-Short Form (PSI-SF) and Coping Health Inventory for Parents (CHIP). T-test/univariate one-way ANOVA, Pearson's r, hierarchical linear regression analysis were conducted to explore the influential factors of resilience. Results: Fathers of patients with cleft lip and/or palate had a higher level of resilience (77.77 ± 14.18) than mothers (74.52 ± 14.33) though without significance. Resilience was positively associated with hope, perceived social support, optimism and coping and negatively correlated with parenting stress both in the fathers and the mothers. Hierarchical linear regression analysis showed that hope (ß = 0.400, P < 0.01), coping (ß = 0.281, P < 0.05), job status, medical payments (ß = -0.240, P < 0.05) were found to be associated with resilience among the fathers of patients with CL/P, and all four variables in the model could explain 42.8% of the variance in resilience; Hope (ß = 0.225, P < 0.05), perceived social support (ß = 0.194, P < 0.05), the age of patients (ß = 0.189, P < 0.05) were found to be associated with resilience among the mothers, and all three variables in the model could explain 27.6% of the variance in resilience. Conclusion: Our study showed that, in China, fathers of patients with cleft lip and/or palate had a higher level of resilience than mothers though without significance. Hope was the only communal variable strongly associated with resilience among both the fathers and the mothers; besides, coping, job status and medical payments were found to be associated with resilience among the fathers; while perceived social support and the age of patients were found to be associated with resilience among the mothers. The results suggest that enhance hope in parents of patients with cleft lip and/or palate might greatly help improve their resilience. Besides, fathers and mothers need specific intervention to prompt their resilience.