Construction of nursing quality standards in patients who underwent spine surgery based on three-dimensional quality model / 中国实用护理杂志

Objective:To explore and construct the nursing quality standards of spine surgery, provide a scientific basis for improving the nursing quality of spine surgery.Methods:Taking the "structure-process-outcome" three-dimensional quality model as the theoretical framework, through evidenced-based literature search and semi-structured interview, the items pool was formed, and finally the nursing quality standards were determined by two rounds of Delphi method of expert inquiry from May to July 2023.Results:The positive coefficients of the two rounds of inquiries to experts were 0.90 and 1.00, respectively. The authority coefficients were 0.946 and 0.951, respectively. The Kendall coefficients of the first, second and third level standards in the first round were 0.161, 0.095 and 0.108, respectively, and the Kendall coefficients of the first, second and third level standards in the second round were 0.162, 0.088 and 0.100, respectively, the differences were statistically significant (all P<0.05). The final nursing quality standards were finally constructed, including 3 first-level standards (structural quality, process quality and outcome quality), 20 second-level standards and 60 third-level standards.Conclusions:The nursing quality standards of spine surgery based on the three-dimensional quality model of "structure-process-outcome" have high reliability and science, which can provide target incentives for clinical nurses, provide a basis for the quality of specialized spine nursing, and promote the development of nursing specialization and the construction of nursing discipline.

Pregnancy with recurrent endometrial stromal sarcoma: a case report / 中华围产医学杂志

This paper reported the clinical characteristics, diagnosis, and treatment of a case of recurrent endometrial stromal sarcoma with term pregnancy. The patient had undergone laparoscopic surgery to remove hysteromyoma before conception in 2017, which was pathologically diagnosed as low-grade endometrial stromal sarcoma after surgery. Due to her strong reproductive willingness, the patient attempted to conceive in light of her stable condition and no evidence of recurrence and was closely followed up with an informed choice. She conceived successfully in 2020 and underwent regular pregnancy examinations. Ultrasound examination at 37 +4 weeks of gestation revealed a slightly hypoechoic mass of about 6.3 cm×4.5 cm size in the pelvic cavity. After admission, a pelvic MRI indicated multiple solid nodules in the right adnexa uteri and beside the iliac vessels in the left pelvic wall and anterior pelvic wall with the larger one being about 58 mm×28 mm. Diffusion-weighted imaging showed multiple pelvic nodules and masses with significant diffusion restriction. The patient was diagnosed as having multiple solid nodules and masses in the pelvic cavity, and the recurrence of sarcoma was highly suspected. Brain CT and lung CT showed no obvious metastatic lesions. A consultation involving the Department of Gynecological Tumor Chemoradiotherapy was held and the sarcoma recurrence during pregnancy was prenatally diagnosed. After ruling out the contraindications for surgery, a cesarean section was performed in the lower segment of uterus under general anesthesia and a live female baby was delivered at 38 ＋3 weeks. The excised mass was confirmed as recurrent uterine stromal sarcoma by rapid freezing pathology during cesarean section. A combination surgery was performed subsequently, including total extra-fascial hysterectomy, bilateral oophorectomy, bilateral salpingectomy, appendectomy, greater omentum resection, pelvic lesion resection (right side), and pelvic adhesiolysis. Recurrent low-grade uterine stromal sarcoma was reconfirmed by postoperative pathology. The patient was discharged after recovery. After two years of follow-up, no distant metastasis recurrences were found.

Mechanism of Dahuang Zhechongwan in Treating Myocardial Fibrosis of Rats via TGF-β1/Smads/miR29 Pathway / 中国实验方剂学杂志

ObjectiveTraditional Chinese medicine， namely Dahuang Zhechongwan （DHZCW） was used to treat myocardial fibrosis in model rats， observe its effect on myocardial fibrosis in rats， and explore its action mechanism. MethodThirty-six SPF male Kunming rats were divided into blank group， model group， low-， medium-， high-dose groups of DHZCW （0.056， 0.084， 0.168 g·kg-1）， captopril group （10 mg·kg-1）， with six rats in each group. Except for the blank group， the other groups were intraperitoneally injected isoproterenol solution of 5 mg·kg-1 for 15 consecutive days to replicate the myocardial fibrosis model. At the beginning of modeling， the rats in each group took drugs， and they were sacrificed 28 days after administration. Serum and heart tissue were collected for the corresponding detection. Hematoxylin-eosin （HE） staining and Masson staining were used to observe tissue inflammation， cellular degeneration， necrosis， and fibrosis. The contents of hydroxyproline （HYP）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， hyaluronic acid （HA）， laminin （LN）， type-Ⅲ procollagen （PC Ⅲ） in serum of rats and rats were determined by enzyme-related immunosorbent assay （ELISA）. The expression levels of key pathway proteins transforming growth factor-β1 （TGF-β1）， α-smooth muscle actin （α-SMA）， Smad2， Smad3， and Smad7 were detected by Western blot. The expression levels of key pathway genes TGF-β1， α-SMA， Smad2， Smad3， Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， the pathological changes of fibrosis in the model group were obvious， the contents of serum HYP， TNF-α， IL-1β， IL-6， HA， LN， and PCⅢ were increased （P<0.01）， the protein expression levels of TGF-β1， α-SMA， Smad2， and Smad3 were increased； the protein expression level of Smad7 was decreased （P<0.01）. The mRNA expression levels of TGF-β1， α-SMA， Smad2， and Smad3 were increased （P<0.05， P<0.01）， while those of Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were decreased （P<0.01）. Compared with the model group， after 28 days of administration， serum HYP， TNF-α， IL-1β， IL-6， HA， LN， and PCⅢ in high-， medium-， and low-dose groups of DHZCW and captopril groups were decreased （P<0.01）. Except for the low-dose group， the protein contents of TGF-β1， α-SMA， Smad2， and Smad3 were decreased， while the protein content of Smad7 was increased （P<0.01）. The mRNA expression levels of TGF-β1， Smad2， α-SMA， and Smad3 in high-dose group of DHZCW were decreased （P<0.05，P<0.01）， while those of Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were increased （P<0.05）. The mRNA expressions of TGF-β1， Smad2， and Smad3 in the medium-dose group of DHZCW were decreased （P<0.05， P<0.01）， while mRNA expression of Smad7 was increased （P<0.01）. The mRNA levels of TGF-β1 and Smad2 in the low-dose group of DHZCW were decreased （P<0.01）. ConclusionDHZCW can improve myocardial fibrosis in rats， and its action mechanism may be related to the regulation of the TGF-β1/Smads/miR-29 pathway. In addition， there is dose dependence in the range of 0.056-0.168 g·kg-1， and the effect of the high-dose group is more stable.

Protective Effect of Alcohol Extract of Phyllanthi Fructus on Silicosis Mice and Its Correlation with Nrf2/ARE Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the effect and underlying mechanism of alcohol extract of Phyllanthi Fructus on silicosis mice induced by silicon dioxide （SiO2）. MethodThirty-six male Kunming mice of SPF grade were randomly divided into a blank group，a model group，high-， medium， and low-dose Phyllanthi Fructus groups （800， 400， 200 mg·kg-1），and a tetrandrine group （0.039 mg·kg-1），with six mice in each group. The silicosis model was induced by static SiO2 exposure in mice except for those in the blank group. After 28 days of administration by gavage，the lung tissues were collected and the organ coefficient was calculated. Hematoxylin-eosin（HE）staining and Masson staining were used to detect the morphology of lung tissues. The content of hydroxyproline （HYP），superoxide dismutase （SOD），malondialdehyde （MDA）， and catalase （CAT） in serum was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot and Real-time polymerase chain reaction（Real-time PCR） were used to detect the protein and mRNA expression of nuclear factor E2-related factor 2 （Nrf2），heme oxygenase-1 （HO-1），NAD（P）H：quinone oxidoreductase 1 （NQO1），and Kelch-like ECH-associated protein 1 （Keap1）， respectively. ResultCompared with the blank group，the model group showed seriously damaged morphological structure of lung tissues with inflammatory cell infiltration and fibrous tissue proliferation， reduced serum content of SOD and CAT（P<0.01），increased content of HYP and MDA（P<0.01）， down-regulated protein and mRNA expression of Nrf2，HO-1， and NQO1（P<0.01），and up-regulated protein and mRNA expression of Keap1 （P<0.05，P<0.01）. Compared with the model group，the high- and medium-dose Phyllanthi Fructus groups showed significantly restored morphological structure of lung tissues with reduced collagen deposition， increased serum content of SOD and CAT（P<0.05，P<0.01），decreased content of HYP and MDA（P<0.01）， up-regulated protein and mRNA expression of Nrf2，HO-1， and NQO1 （P<0.05，P<0.01），and down-regulated protein and mRNA expression of Keap1（P<0.05，P<0.01）. ConclusionThe alcohol extract of Phyllanthi Fructus can inhibit pulmonary fibrosis in silicosis mice，and the underlying mechanism may be related to the regulation of the Nrf2/antioxidant response element （ARE） signaling pathway.

Mechanism research progress on the microglia evolution in aging / 中华老年医学杂志

The results clearly demonstrate the close relationship between the evolution of microglia and the mechanisms underlying aging.Monitoring the status of microglia can greatly contribute to diagnosing aging and related neurodegenerative diseases.Furthermore, protecting the function of microglia is a viable strategy for slowing down brain aging and preserving brain function.This approach offers a feasible intervention strategy for tackling aging and degenerative diseases.This paper provides a comprehensive summary of the changes that occur in microglia during the aging process.It also examines the impact of these changes in microglia function on neurons and astrocytes in the brain.

Mechanism of Dahuang Zhechongwan in Inhibiting Renal Fibrosis in Rats by Regulating Intestinal Flora Based on 16S rDNA Sequencing / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of Dahuang Zhechongwan （DHZCW） on adenine-induced renal fibrosis in rats from the perspective of intestinal flora. MethodThirty-six SD rats were randomly divided into a blank group， a model group， and high-， medium- and low-dose DHZCW groups （0.168， 0.084， 0.042 g·kg-1）， and a pirfenidone group （200 mg·kg-1）， with 6 rats in each group. Except for those in the blank group， rats in other groups were treated with adenine suspension （250 mg·kg-1） by gavage for 28 days for renal fibrosis model induction. Subsequently， they received drug intervention for 4 weeks. Urine samples were collected from rats in metabolic cages， and renal function indicators including blood urea nitrogen （BUN）， urea， creatinine （Crea）， cystatin C （Cys C）， and 24-hour urine protein （24 h TP） were measured. Kidney samples were collected and subjected to hematoxylin-eosin （HE） staining and Masson's trichrome staining to observe the pathological changes in rat renal tissues. Western blot was used to detect the expression levels of key effector proteins α-smooth muscle actin （α-SMA）， type Ⅰ collagen （ColⅠ）， and type Ⅲ collagen （ColⅢ） in the kidneys. High-throughput sequencing of 16S rDNA was used to analyze the species diversity of rat intestinal flora. ResultCompared with the blank group， the model group showed increased BUN， urea， Crea， Cys C， and 24 h TP levels （P<0.01）. Compared with the model group， the high-， medium-， and low-dose DHZCW groups， as well as the pirfenidone group， showed significant reductions in BUN， urea， Crea， Cys C， and 24 h TP levels （P<0.01）， indicating that DHZCW intervention significantly improved renal function. In the model group， renal tissues exhibited significant fibrotic changes， and the protein levels of α-SMA， ColⅠ， and ColⅢ were significantly increased （P<0.01） compared to those in the blank group. Compared with the model group， the high-dose DHZCW group and the pirfenidone group had relatively normal tissue structure， with no significant pathological damage observed. However， fibrotic changes were observed in the medium- and low-dose DHZCW groups， with the changes being more significant in the low-dose group. The protein levels of α-SMA， ColⅠ， and ColⅢ were significantly decreased in the high-， medium-， and low-dose DHZCW groups， as well as the pirfenidone group （P<0.01）， indicating that DHZCW effectively reduced abnormal collagen deposition and inhibited renal fibrosis. From the perspective of intestinal flora， at the phylum level， compared with the blank group， the model group showed a significant increase in the abundance of Firmicutes and a decrease in Bacteroidetes， leading to a significant imbalance in their ratio. At the family level， the model group decreased the abundance of Lachnospiraceae， Prevotellaceae， and Bacteroidota_unclassified， and increased the abundance of Ruminococcaceae， Lactobacillaceae， and Oscillospiraceae. At the genus level， the model group showed significantly reduced abundance of Firmicutes_unclassified， Bacteroidota_unclassified， and Prevotellaceae_UCG-001， etc.， and increased abundance of UCG-005， Clostridia_UCG-014_unclassified， etc. Compared with the model group， DHZCW effectively reduced the abundance of potential pathogenic bacteria and increased the abundance of beneficial bacteria， regulating the intestinal flora. ConclusionDHZCW can effectively improve renal function and inhibit renal fibrosis， and its mechanism of action may be related to the regulation of intestinal flora.

Preparation of Cas9 - RNP cell membrane vesicle －loaded biomimetic nanoparticles and its efficacy on the NLRP3 gene / 安徽医科大学学报

Objective @# Cas9-RNP biomimetic nanoparticles cas9-RNP@ MMs were prepared by encapsulating the Cas9 Ribonucleoprotein complex (RNP) using mouse macrophage membranes，with the aim of utilizing this biomimetic nanoparticle to deliver the Cas9-RNP complex for gene editing ，and further study the endocytosis of Cas9- RNP@ MMs and its gene editing effect in mouse macrophage RAW264. 7 in vitro ，providing evidence for the development oflow-toxicity biomimetic nanoparticle carriers that inhibit NLRP3 therapeutic targets．@*Methods @#The purified mouse macrophage membrane was mixed with the prepared cas9-RNP mixture，and after ultrasound，the CAS9- RNP@ MMS was obtained by liposome extrusion instrument ; The particle size of Cas9-RNP@ MMswas measured by nanoparticle tracking analysis，and the particle morphology of Cas9-RNP@ MMs was observed under transmission electron microscope．Laser confocal Fluorescence microscope imaging was used to analyze the endocytosis Cas9-RNP @ MMs．The Biocompatibility of Cas9-RNP@ MMs was measured by MTT assay．The expression of NLRP3 was detected by qPCR and Western blot to verify the knockdown effect of Cas9-RNP@ MMs on NLRP3 gene. @*Results@#The average particle diameter of Cas9-RNP@ MMs prepared from macrophages was about 216 nm．Under laser confocal fluorescence microscope，the Cas9-RNP@ MMs could be successfully endocysed by Raw246. 7 cell．MTT assay indicated that the Cas9-RNP@ MMs-treated mouse macrophage RAW246. 7 had good biocompatibility．qPCR and Western blot showed that two NLRP3-specific guide RNA were mediated by Cas9-RNP@ MMs，with good effect of knockdown NLRP3 gene expression．@*Conclusion@# Nano-scale vesicles Cas9-RNP@ MMs loaded with Cas9-RNP complexes were successfully prepared by biomimetic nanoparticles． Cas9-RNP@ MMs have good biocompatibility and can be efficiently endocytosed by RAW246. 7 cells．Cas9-RNP@ MMs containing NLRP3-specific sgRNA can specifically knock down NLRP3 gene expression.

Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency / 中国药房

OBJECTIVE To provide a reference for the safe use of drugs in patients with complex venous thromboembolism （VTE） and acute renal insufficiency. METHODS Clinical pharmacists participated in the management of anticoagulant therapy for a patient with complex VTE complicated with acute renal insufficiency， and evaluated the patient as high-risk thrombosis and bleeding based on their medical history， laboratory test results， etc.； combined with the complexity of thrombosis and renal insufficiency， clinical pharmacists suggested that enoxaparin sodium should be used in the acute stage of thrombosis （5 to 21 days after onset）， and then warfarin should be adopted for oral anticoagulation treatment. Because the patient’s anticoagulation was not up to the standard （the target range of the international normalized ratio was 2-3）， clinical pharmacists suggested increasing the warfarin dose， detecting the warfarin metabolism genotype， and adjusting the warfarin dose according to the genotype； at the same time， clinical pharmacists developed an anticoagulation monitoring plan to ensure the safety of anticoagulation treatment. RESULTS Doctors had adopted all the recommendations of clinical pharmacists. The patient did not experience adverse events such as bleeding or worsening of thromboembolism during anticoagulation in the hospital. When the anticoagulation met the standards， the patient was allowed to be discharged with medication. CONCLUSIONS By participating in the anticoagulation treatment management of patients with complex VTE and acute renal insufficiency， clinical pharmacists have assisted doctors in formulating personalized anticoagulation plans to promote the compliance with the anticoagulation treatment standard and ensure the safety and effectiveness of medication for patients.

Effects of sunlike spectrum LED illumination on retinal blood perfusion in children and adolescents: a randomized controlled trial / 中国学校卫生

Objective@#To analyze the effect of sunlike spectrum LED illumination on retinal blood flow perfusion, and to explore the the correlation between sunlike spectrum LED illumination and eye health indicators in children and adolescents.@*Methods@#A randomized control double blind trial was conducted. The ordinary LED table lamp in the control group(11) and the sunlike spectrum LED table lamp in the experimental group(12) had a fitting degree of 87% and 95% with the daylighting spectrum, respectively. Two sample independent t test and multivariable linear regression model were applied to compare the changes of retinal blood perfusion before and after the trial.@*Results@#After near reading for 1 hour, the retinal capillary density in the superficial and deep layers of the subjects in the ordinary LED illumination group decreased (superficial layer: -3.05±2.04 , P <0.01; deep layer: -4.03± 4.94, P =0.02), no significant decrease was found in the sunlike spectrum LED illumination group (superficial layer: -0.59± 1.44, P =0.18; deep layer: -0.49±4.27, P =0.70). Multivariable regression analysis found that compared with ordinary LED illumination, sunlike spectrum LED illumination could significantly alleviate the decrease in capillary density in the superficial and deep retinal layers, respectively ( β =2.83, 95% CI =1.54-4.12, P <0.01; β =4.21,95% CI =0.58-7.84, P =0.02).@*Conclusion@#Sunlike spectrum LED illumination can alleviate the decrease in retinal blood perfusion caused by near work among children and adolescents, suggesting that it may delay the onset and development of myopia. Prevention and control of myopia needs to pay attention to the spectral power distribution of artificial illumination.

Diagnostic value of two-dimensional ultrasound combined with volume contrast imaging and MRI in fetal corpus callosum dysplasia / 国际生物医学工程杂志

Objective:To investigate the diagnostic value of two-dimensional ultrasound combined with volumetric contrast imaging (VCI) and magnetic resonance imaging (MRI) for the developmental abnormalities of the fetal corpus callosum.Methods:Seventy-three fetuses who underwent cranial MRI within 1 week after suspected fetal corpus callosum dysplasia on ultrasound and received a definitive diagnosis in the neonatal period were retrospectively recruited for the study. The fetal corpus callosum was observed in the transverse, coronal, and sagittal views of the fetus, and the hyaline septal cavity, lateral ventricle, third ventricle, and corpus callosum were observed in the MRI scan. The diagnostic results and sensitivity of two-dimensional ultrasound combined with volumetric contrast imaging and MRI were analyzed.Results:Neonatal imaging showed that among 73 fetuses, 32 had agenesis of the corpus callosum, 29 had hypoplasia of the corpus callosum, and 12 had normal development of the corpus callosum. The differences in diagnostic results and sensitivity between 2D ultrasound combined with volumetric contrast imaging and MRI testing for agenesis of the corpus callosum were not statistically significant (all P>0.05), and the differences in diagnostic results and sensitivity for hypoplasia of the corpus callosum were statistically significant ( P<0.05). Conclusions:Both 2D ultrasound combined with volumetric contrast imaging and MRI are of high value for the diagnosis of partial-type agenesis of the corpus callosum, but MRI is more advantageous for the diagnosis of agenesis of the corpus callosum, and MRI can be a useful supplement and verification tool for ultrasound to provide a more accurate clinical diagnosis.

Research progress on neural mechanism of orthographic processing in children with Chinese developmental dyslexia / 中国学校卫生

Abstract@#The possible mechanisms of developmental dyslexia mainly include the hypothesis of language framework and the hypothesis of non-verbal framework. The language framework assumes that people with developmental dyslexia may exhibit defects in phonetic awareness, rapid naming, phonetic memory, and orthographic processing. Studies of developmental dyslexia in Chinese have found that deficiencies in orthography may be an important cause of dyslexia, but there are diverse views and opinions regarding orthography processing. This article sorts out the research progress in behavioral and neuroimaging aspects of orthography studies, and provides references for further development of processing test materials and methods in the research of processing mechanism of developmental dyslexia orthography.

Visual attention span and intervention effect of acttion video game in children with developmental dyslexia / 中国学校卫生

Objective@#To characterize visual attention span in children with developmental dyslexia in Xinjiang and to explore the effects of action video game training on visual attention span,and to provide a reference for improving the visual attention span of children with dyslexia.@*Methods@#Students from grade 3 to 5 in primary schools of Xinjiang were selected by using random clustering sampling method from July to November 2020,a total of 120 developmental dyslexia group (Group-DD), chronological age matched group (Group-CA) and reading level matched group (Group-RL) were selected and compared with visual attention spans, action video games were used to conduct intervention training for DD children, variance analysis was used to study the variation of visual attention span.@*Results@#The accuracy and discrimination index of Group-DD (0.68±0.10, 1.21±0.87) were lower than those of Group-CA (0.77±0.99, 1.80±0.83) and Group-RL (0.71±0.11, 1.50±0.75) ( F =21.26, 15.19, P <0.05);there was no significant difference in reaction time among the three groups( P >0.05). There were statistically significant differences in the accuracy of visual attention span (0.63±0.12, 0.71±0.11,0.70±0.10), response time (760.51±185.83, 782.74±149.20, 857.27± 155.44 ), and discrimination (0.84±0.81, 1.51±0.19, 1.29±0.10) among children of different grades ( F =6.37，3.81，3.16， P < 0.05 ). After 12 hours of action video game training, the accuracy and discrimination of Group-DD intervention group (0.74±0.10, 1.53±0.88) were higher than those of Group DD control group (0.68±0.14, 1.06±0.97)( P <0.05), and there was no significant difference between Group DD intervention group and Group RL (0.76±0.12, 1.73±0.71) ( P >0.05), but there was statistical difference between Group DD intervention group and Group-CA (0.81±0.94, 2.17±0.79) ( P <0.05).@*Conclusion@#Children with dyslexia have deficits in visual attention span, with grade difference. Action video game intervention can improve visual attention span ability of developmental dyslexia children to some extent.

Research progress in characteristics of B cells in high-, low- and non-responsive individuals after HBV vaccination / 中华微生物学和免疫学杂志

Hepatitis B virus (HBV) infection remains a serious global health problem, which can lead to acute and chronic liver diseases and a variety of complications. HBV vaccination, which induces B cells to secrete protective hepatitis B surface antibody (HBsAb), is an important measure to prevent HBV infection. Some studies have shown that different individuals have different responses to HBV vaccine, which can be divided into ultra-high/high, normal/medium and low/non-response. Research on the potential mechanisms can provide reference for the preparation of high-titer HBsAb and the prevention and treatment of HBV infection. This paper reviewed the research situation and progress in the characteristics and mechanism of B cells in different responders after HBV vaccination.

Correlation between CYP2C19 gene polymorphism and individualized medication in patients with ischemic stroke / 中国临床药理学与治疗学

AIM: To investigate the guiding role of individualized medication adjustment based on CYP2C19 metabolic typing in the treatment of ischemic stroke with clopidogrel, and to provide reference for clinical individualized medication. METHODS: The total of 80 patients with ischemic stroke were divided into the individualized drug instruction group with gene detection (n=40) and the control group without gene detection (n=40) according to whether they received CYP2C19 gene detection. According to the metabolism of CYP2C19, the individualized medication instruction group was divided into slow metabolic type, intermediate metabolic type, fast metabolic type and ultra-fast metabolic type. Patients with fast and ultra-fast metabolites were given clopidogrel dose of 75 mg once a day. Patients with intermediate metabolic type were given double clopidogrel dose of 150 mg once a day. Patients with slow metabolism were given tigrillo dose of 90 mg twice a day or aspirin dose of 100 mg once a day. The control group received 75 mg clopidogrel once a day. All patients enrolled in the groups were followed up for 3 months by outpatients or telephone. The incidence of vascular events and mRS scale scores were compared between the two groups. RESULTS: The incidence of vascular events in the individualized drug instruction group was significantly lower than that in the control group, and the incidence of mRS score(0-1) was significantly higher than that in the control group, with statistically significant differences (P<0.05). CONCLUSION: The individualized medication for patients with ischemic stroke by CYP2C19 gene detection can significantly reduce the incidence of adverse vascular events and improve the prognosis and living ability of patients.

Peak bone mass in Chinese adolescents: the importance of adequate calcium intake / 中华内分泌代谢杂志

Attaining higher peak bone mass and strength in early life stage is critical for reducing risk of osteoporosis or lower bone mass later in life. Genetic factors such as race and gender are mostly responsible for the variability and timing of reaching peak bone mass. In general, Asians have lower areal bone mineral density and would reach peak bone mass earlier when they are compared to Caucasians. Among different lifestyle factors, strong evidence is only available for positive effects of dietary calcium and physical exercise on bone accretion. Studies showed that the calcium intake of Chinese population at all ages is well below the recommended intake levels. To develop peak bone mass and strength to reach their genetic potentials, achieving adequate calcium and vitamin D intake through promoting dietary intake and/or supplementation, are strongly recommended, especially in Chinese adolescents.

A survey on the smart medical service model in Hangzhou: signing behavior and associated factors / 中华全科医师杂志

To analyze the associated factors of signing behavior of the smart medical service model in Hangzhou, 500 residents aged 18 years and older who signed the smart medical service and 500 unsigned residents were randomly selected from 5 urban districts of Hangzhou city from 19 to 26, July 2016. The social-demographic characteristics, chronic disease, health-seeking behavior, kinds of medical insurance were investigated by face-to-face interview. The results showed that there were significant differences in educational level, self-rated health status, chronic disease, seeking behavior and type of medical insurance, while there were no significant differences in gender and age between the signed group and the non-signed group. Logistic regression analysis revealed that residents with higher education level (OR=1.226, 95%CI: 1.118-1.344, P<0.01) and having more chronic diseases (OR=1.854, 95%CI: 1.524-2.257, P<0.01) preferred to sign the service contract. The main reasons for unwillingness of signing contract were " the service was not suitable for me" (17.0%, 61/359), "I didn′t know the specific content of the service" (16.7%,60/359), "the signing procedure was complicated" (15.0%, 54/359). In conclusion, different communication strategies should be adopted considering residents with different educational level and chronic diseases. And delivery of detailed information, simplification of signing process will promote to popularize this smart medical service.

A survey on the smart medical service model in Hangzhou: signing behavior and associated factors / 中华全科医师杂志

To analyze the associated factors of signing behavior of the smart medical service model in Hangzhou,500 residents aged 18 years and older who signed the smart medical service and 500 unsigned residents were randomly selected from 5 urban districts of Hangzhou city from 19 to 26,July 2016.The social-demographic characteristics,chronic disease,health-seeking behavior,kinds of medical insurance were investigated by face-to-face interview.The results showed that there were significant differences in educational level,self-rated health status,chronic disease,seeking behavior and type of medical insurance,while there were no significant differences in gender and age between the signed group and the non-signed group.Logistic regression analysis revealed that residents with higher education level (OR=1.226,95％CI:1.118-1.344,P＜0.01) and having more chronic diseases (OR=1.854,95％CI:1.524-2.257,P＜0.01) preferred to sign the service contract.The main reasons for unwillingness of signing contract were"the service was not suitable for me"(17.0％,61/359),"I didn't know the specific content of the service"(16.7％,60/359),"the signing procedure was complicated"(15.0％,54/359).In conclusion,different communication strategies should be adopted considering residents with different educational level and chronic diseases.And delivery of detailed information,simplification of signing process will promote to popularize this smart medical service.

Expert recommendation for outdoors activities as myopia prevention and control in children and adolescents / 中国学校卫生

Abstract@#China has one of the world’s highest prevalence of myopia in children and adolescents, and children are developing myopia earlier. Myopia has become a important issues affecting children and adolescents health, as well as a significant public health concern. There has been continuing debate over the role of nature and nurture in the aetiology of myopia, growing evidence showed that environmental factors has a determine effect on myopia.The randomized controlled trials has assured the relationship between time outdoors and myopia. Based on reviewed published articles, survey and intervention studies and school health practices, according to the principle of school organization, student participation and family cooperation, the authors proposed outdoors activities as initiative for myopia prevention and control in children and adolescents. The detail recommendation contents, levels were list out.

Effects of cholesterol-lowering probiotics on intestinal barrier and gut microbiota in mice with non-alcoholic fatty liver disease and the possible mechanisms / 中华微生物学和免疫学杂志

Objective To investigate the effects of cholesterol-lowering probiotics, DM9054 com-bined with 86066, on the intestinal mucosal barrier and gut microbiota in mice with nonalcoholic fatty liver disease ( NAFLD) induced by high-fat diet and the possible mechanisms. Methods Twenty-four male mice deficient in the low-density lipoprotein receptor gene ( Ldlr- / - mice ) were randomly divided into three groups including control, NAFLD model and probiotic intervention groups. Mice in the three groups were given normal chow diet+normal saline, high-fat diet ( HFD)+normal saline, and HFD+cholesterol-lowering probiotics, respectively. The mouse model of NAFLD was established by feeding mice with high-fat diet (45％ of calories derived from fat diet) for 12 weeks. qPCR was performed to measure the expression of liv-er and intestinal inflammatory genes and liver cholesterol synthesis genes. Western blot assay was used to de-tect the expression of intestinal tight junction proteins and HMG-CoA reductase ( HMGCR ) . Pathological changes in tissues were evaluated by HE staining. Features of gut microbiota were analyzed by 16S rRNA gene sequencing. Results Cholesterol-lowering probiotics intervention attenuated HFD-induced hepatic steatosis, inflammatory responses and obesity and decreased the synthesis of liver cholesterol (P<0. 05). Moreover, inhibited gut inflammatory responses and improved intestinal barrier function were detected in the probiotic intervention group (P<0. 05). The composition of gut microbiota in mice of the probiotic intervention group was different from that of the model group, but similar to that of the control group. Con-clusions Cholesterol-lowering probiotics might attenuate NAFLD in mice through reducing liver cholesterol synthesis, alleviating liver and intestinal inflammation, improving intestinal mucosal barrier function and reg-ulating intestinal microbiota.

Effect of silent information regulator 2 homologue 1 activity on angiogenesis in cerebral ischemia rats / 中华神经科杂志

Objective To investigate the effect of silent information regulator 2 homologue 1 (SIRT1) activity on angiogenesis in cerebral ischemia rats and its related mechanisms .Methods One hundred and twenty healthy male Sprague-Dawley rats were randomly divided into four groups by random numbers:control group , the cerebral ischemia-reperfusion injury model group ( model group ) , the SIRT1 agonist group (agonist group) and the SIRT1 inhibitor group (inhibitor group), with 30 rats in each group. A model of transient middle cerebral artery occlusion was performed by the suture method .After reperfusion for 24 h, neurological deficit scores were evaluated . Cerebral infarct area after middle cerebral artery occlusion ( MCAO) in rats was determined by staining with triphenyltetrazolium chloride .SIRT1 deacetylase activity was detected by ELISA in ischemic brain tissue.By immunohistochemistry, we observed CD34 expression and detected microvascular density ( MVD) in ischemic cerebral cortex.Immunoblotting was carried out to evaluate protein levels of SIRT 1, vascular endothelial growth factor (VEGF) and erythropoietin (EPO) in ischemic brain tissue.Results Compared with the control group ((13.828 ±0.828) U/L), SIRT1 deacetylase activity was significantly reduced in ischemic brain in the model group ((7.721 ±0.581) U/L,t=8.650,P<0.01).Compared with the model group , SIRT1 deacetylase activity was significantly increased in ischemic brain in the agonist group ((26.165 ±0.971) U/L,t=-26.123,P<0.01). Compared with the agonist group , SIRT1 deacetylase activity was significantly reduced in ischemic brain in the inhibitor group ((17.094 ±1.012)U/L,t=12.848,P<0.01).Neurological deficit score was 2.667 ± 0.516 in the model group.When SIRT1 was activated in ischemic brain , neurological deficit score was significantly lower (1.333 ±0.516,t=4.822,P<0.01) than that of the model group .When SIRT1 activity was inhibited, the neurological deficit score increased significantly ( 2.500 ±0.548, t=-4.147, P<0.01).The cerebral infarction area was 15.473％ ±3.049％ in the model group.When SIRT1 was activated in ischemic brain , the cerebral infarction area was significantly reduced ( 9.152％±1.803％,t=3.188,P<0.05).Immunohistochemical results showed that the brown cells in the ischemic cortex were CD34 staining positive cells.When SIRT1 was activated in ischemic brain , the MVD count significantly increased in ischemic cerebral cortex ( the agonist group:8.167 ±1.941/high power lens ,the model group:3.167 ±0.753/high power lens,t=-6.864,P<0.01).Immunoblotting demonstrated that the activation of SIRT1 increased the protein expressions of VEGF (the agonist group:0.568 ±0.012,the model group:0.468 ± 0.008,t=-11.034,P<0.01) and EPO (the agonist group:0.646 ±0.010,the model group:0.471 ± 0.013,t=-20.952,P<0.01) in ischemic brain.Conclusions Activation of SIRT1 has neuroprotective effect on cerebral ischemia-reperfusion injury rats.SIRT1 can promote angiogenesis in the early stage of cerebral ischemia reperfusion via directly increasing the expressions of VEGF and EPO in ischemic brain .