A multicenter, randomized controlled study on the efficacy of agomelatine in ameliorating anhedonia, reduced motivation, and circadian rhythm disruptions in patients with major depressive disorder (MDD).

OBJECTIVE: To evaluate the clinical efficacy and safety of Agomelatine in improving symptoms in patients with major depressive disorder (MDD), providing more scientific evidence for the treatment of depression, and offering more effective therapeutic options for patients. METHODS: A total of 180 MDD patients in acute phase from 10 psychiatric hospitals of Grade three in Zhejiang Province were enrolled in this 12-week study with the competitive and consecutive pattern, and they were randomized into two different groups treated with flexible-dosage antidepressants of selective serotonin reuptake inhibitors (SSRI) or agomelatine, respectively. The subjects were evaluated with psychological scales of HAMD-17, HAMA, SHAPS for anhedonia, MFI-20 for fatigue, PQSI for sleep quality and MEQ for disturbances in chronobiologic rhythms at baseline, 2, 4, 8 and 12-weekend points, and TESS was used for side-effect. The results were analyzed with repeated measurement analysis of variance. RESULTS: The two groups each had 90 participants, and there were no significant differences at baseline. The scores of various assessment scales showed statistically significant time main effects during the visits (P < 0.01). The Agomelatine group demonstrated faster efficacy within 2 weeks, with better improvement in SHAPS, MEQ, and PSQI compared to the SSRIs group. However, the remission rate at 12 weeks was lower in the Agomelatine group than in the SSRIs group (63.3% and 72.2%), but the difference between the groups was not statistically significant. The Agomelatine group had fewer adverse reactions (14.4% and 16.7%), but there was a slightly higher incidence of liver function impairment (6.7% and 4.4%), with no statistically significant difference between the groups. CONCLUSION: Agomelatine, as a novel antidepressant, shows certain advantages in improving depression and anxiety symptoms and is comparable to SSRIs in terms of safety. However, its long-term efficacy and safety on MDD or other depressive subtypes still require further observation and research.

Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review.

There are various types of traumatic stimuli, such as catastrophic events like wars, natural calamities like earthquakes, and personal trauma from physical and psychological neglect or abuse and sexual abuse. Traumatic events can be divided into type I and type II trauma, and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals' self-evaluation of the traumatic events. Individual stress reactions to trauma include posttraumatic stress disorder (PTSD), complex PTSD and trauma-related depression. Trauma-related depression is a reactive depression with unclear pathology, and depression occurring due to trauma in the childhood has gained increasing attention, because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy, which is similar to the pattern observed for PTSD. Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse, it is necessary to explore its pathogenesis and therapeutic strategy.

Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall / 中华外科杂志

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Application effect of immersive experiential teaching strategies in the teaching of clinical anesthesiology for undergraduates / 中华医学教育探索杂志

Objective:To explore the application effect of immersive experiential teaching strategies in the teaching of clinical anesthesiology for undergraduates.Methods:Undergraduates majoring in 5-year clinical medicine in Air Force Medical University from January 2022 to May 2022 were enrolled as the research objects. Students were randomly divided into the immersive teaching group and the traditional teaching group, with 35 students in each. Students in the immersive teaching group underwent immersive experiential teaching strategies and the traditional teaching group received lecture-based teaching strategies. After classes, all students in these two groups took the same theoretical and operational examination, and conducted a teaching satisfaction survey and a comprehensive ability evaluation. The results were analyzed by t-test and Chi-square test using SPSS 22.0 software. Results:Students in the immersive teaching group were more satisfied with teaching (88.32±7.28 vs.70.15±7.11) ( P=0.001), and had higher scores of theorical examination (86.34±7.42 vs. 77.31±5.32) ( P=0.020) and operational examination (92.23±5.33 vs. 81.21±4.98) ( P=0.022) than those in the traditional teaching group. In addition, the scores of communication ability ( P=0.026), response ability ( P<0.001) adaptability ( P=0.007), and critical thinking ( P<0.001) in the immersive teaching group were higher than those in the traditional teaching group. Conclusion:The immersive experiential teaching strategies can effectively improve the theoretical and practical operational ability of undergraduates after completing courses of clinical anesthesiology, and can effectively stimulate the enthusiasm of students. It is worthy to be popularized in subsequent teaching abilities.

The Immunity Protection of Central Nervous System Induced by Pseudorabies Virus DelgI/gE/TK in Mice.

Based on a variant strain, we constructed a gE/gI/TK-deleted pseudorabies virus (PRV). A total of 18 female mice were randomized to a vaccination group to receive PRV XJ delgE/gI/TK, a vehicle group to receive Dulbecco's modified Eagle's medium, and a mock group to confirm the protection of PRV delgE/gI/TK on the central nervous system in mice. Subsequently, the vaccination and vehicle groups were infected with PRV XJ. The mice in the vehicle group showed more severe neurological symptoms and higher viral loads than those in the vaccination group. The exudation of Evans blue and the expression of tight junction protein showed no difference in all groups. HE staining showed vacuolar neuronal degeneration in the vehicle group brain, but no tissue lesions were observed in the vaccination group. TNF-α, IL-6, and synuclein were upregulated in the brain of mice in the vehicle group, while those were inhibited among mice in the vaccination group. IFN-ß, IFN-γ, ISG15, Mx1, and OAS1 showed no difference in the brain between the vaccination and vehicle groups. In addition, TNF-α and IL-6 were inhibited, and antiviral factors were increased in the intestine of the mice in the vaccination group compared to those in the vehicle group. Our study showed that PRV XJ delgE/gI/TK inhibited neurological damage and the inflammation of the intestine and brain induced by PRV and activated the innate immunity of the intestine.

Correlation between thyroglobulin antibody, thyroid peroxidase antibody,and arteriosclerosis in middle-aged and older adult patients with depression / 中国基层医药

Objective:To investigate the correlation between serum thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) cconcentrations and arteriosclerosis development in middle-aged and older adult patients with depression.Methods:A total of 200 middle-aged and older adult patients with depression who received treatment in the Third People's Hospital of Huzhou from January 2018 to October 2019 were included in this study. They were divided into four groups ( n = 50/group) according to TG-Ab and TPO-Ab test results: TG-Ab-positive (group 1), TPO-Ab-positive (group 2), TG-Ab-positive and TPO-Ab-positive (group 3), TG-Ab-negative and TPO-Ab-negative (control group). Serum thyroid hormone level, ankle-brachial pressure index (ABI), brachial-ankle pulse wave velocity, and the incidences of intima-media thickening and plaque formation in the lower extremity arteries were compared between groups. Results:Total thyroxine concentration in the control group, groups 1, 2 and 3 was (89.96 ± 2.45) nmol/L, (101.29 ± 3.35) nmol/L, (90.09 ± 2.70) nmol/L, (97.55 ± 2.57) nmol/L, respectively. There was a significant difference in total thyroxine concentration between groups ( F = 3.85, P < 0.05). Brachial-ankle pulse wave velocity in the control group, groups 1, 2, and 3 was (1 327.55 ± 67.78) cm/s, (1 510.36 ± 83.05) cm/s, (1 422.71 ± 71.40) cm/s, (1 533.95 ± 87.01) cm/s, respectively. There was a significant difference in brachial-ankle pulse wave velocity between groups ( F = 65.12, P < 0.05). The incidence of intima-media thickening in the control group, groups 1, 2, and 3 was 18% (9/50), 50% (25/50), 32% (16/50), 60% (30/50), respectively. The incidence of plaque formation in the control group, groups 1, 2, and 3 was 22% (11/50), 56% (28/50), 40% (20/50), 70% (35/50), respectively. There were significant differences in intima-media thickening and plaque formation between groups ( χ2 = 21.83, 25.77, all P < 0.001). Logistic multivariate regression analysis showed that age ( OR = 0.953) and TG-Ab ( OR = 1.116) were independent risk factors for developing arteriosclerosis in middle-aged and older adult patients with depression ( P < 0.05). Conclusion:TG-Ab-positive results are an independent risk factor for developing arteriosclerosis in middle-aged and older adult patients with depression. TPO-Ab-positive results have a synergistic effect on the occurrence and development of arteriosclerosis in middle-aged and older adult patients with depression. Monitoring serum TG-Ab and TPO-Ab concentrations is of great clinical significance for the prevention and treatment of arteriosclerosis in middle-aged and older adult patients with depression.

Study on the correlation between radiation dose and breast compression thickness and density in full-field digital mammography combined with digital breast tomosynthesis / 中华放射医学与防护杂志

Objective:To compare and analyze the relationship between average glandular dose (AGD) and breast density and compression thickness in digital breast tomosynthesis(DBT)/full-field digital mammography(FFDM), and to explore the optimal selection and application of imaging parameters for different types of breast (thickness and density) in specific situations.Methods:The clinical data of 229 cases of breast Combo (DBT+ FFDM) were retrospectively analyzed. The compression thickness, AGD, kVp and type of quantified breast density (Q_abd) of CC and MLO view were collected respectively. The relationship between the AGD and the breast compression thickness and Q_abd density classification was analyzed.Results:There was a positive correlation between AGD and compression thickness (CC: r =0.55, 0.53, P< 0.001; MLO: r =0.62, 0.48, P< 0.001) and breast density(CC: r =0.36, 0.39, P< 0.001; MLO: r =0.16, 0.30, P < 0.001) in DBT/FFDM. The difference between groups for AGD was little in CC of DBT, but significant in CC of FFDM(groups by thickness, CC: F =35.29, 31.32, P<0.005; MLO: F =44.83, 27.02, P<0.005; groups by Q_abd, CC: F =18.68, 19.76, P<0.005, MLO: F=4.58, 10.52, P<0.005); the breast Q_abd was inversely proportion to the mean compression thickness (CC: F =16.28, P<0.005; MLO: F =17.81, P<0.005). At the same time, the interaction effect on AGD between the breast density and thickness was considered, and only for the MLO in FFDM mode they had an interaction on AGD ( F =3.16, P =0.005). Conclusions:The cumulative dose of DBT and FFDM may increase the radiation risk. Single-view CC/MLO-DBT or CC/MLO-(DBT+ FFDM)+ single-view MLO/CC-FFDM mode is preferred for mammography, which plays a positive role in radiation risk reduction.

Quantitative Pulmonary Administration of Essential Oil from Alpiniae Zerumbet Fructus for Treatment of Emphysema / 中国实验方剂学杂志

ObjectiveTo investigate the effect of quantitative pulmonary administration of the essential oil from Alpiniae Zerumbet Fructus （EOAZF） on porcine pancreatic elastase （PPE）-induced emphysema in mice and explore its action mechanism. MethodC57BL/6J mice were randomly divided into five group， namely the control group， model group， low- （2 mg·kg-1） and high-dose （20 mg·kg-1） EOFAZ groups， and positive control dexamethasone （DEX，1 mg·kg-1） group. The mice were treated with pulmonary administration of PPE using a microsprayer aerosolizer， once every seven days， for four times in total， for inducing emphysema. During this period， EOFAZ were administered with a quantitative microsprayer aerosolizer once every other day， for 14 times. The lung tissues were then sampled and stained with hematoxylin-eosin （HE） for observing the morphological changes and calculating the pulmonary mean linear intercept （MLI）. The concentrations of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） in the plasma were determined by enzyme-linked immunosorbent assay （ELISA）. The activities of superoxide dismutase （SOD） and catalase （CAT） and the content of malondialdehyde （MDA） in the lung tissues were measured using the biochemical assay kits. The protein expression levels of nuclear factor E2-related factor 2 （Nrf2）， quinone oxidoreductase1 （NQO1）， B cell lymphoma-2 （Bcl-2）-associated X protein （Bax）， and Bcl-2 in lung tissues were detected by Western blot. ResultThe results of lung morphological observation and MLI detection showed that compared with the control group， the model group showed obvious inflammatory infiltration， alveolar enlargement and fusion， and increased MLI （P<0.05）. Compared with the model group， EOFAZ effectively alleviated the pathological changes such as alveolar dilatation， pulmonary inflammatory cell infiltration， and lung cell apoptosis caused by PPE， and decreased the MLI （P<0.05）. As revealed by ELISA， the inflammatory level of mice in the model group increased significantly （P<0.01）， while the TNF-α， IL-1β， and IL-6 levels in the plasma were decreased after quantitative administration of EOFAZ （P<0.01）. Compared with the control group， the model group exhibited significantly enhanced oxidative stress （P<0.01）. After treatment with EOFAZ by quantitative administration， the activities of SOD and CAT in the lung tissue were increased （P<0.01） and the content of MDA was decreased （P<0.01）. Western blot results demonstrated that the apoptosis-related protein expression in the model group was increased significantly as compared with that in the control group （P<0.01）， whereas the expression levels of antioxidant stress proteins Nrf2 and NQO1 declined （P<0.05）. The relative protein expression of apoptosis-related proteins Bax/Bcl-2 in the EOFAZ groups was lower than that in the model group （P<0.01）， while the expression of antioxidant stress proteins Nrf2 and NQO1 was higher （P<0.05）. ConclusionQuantitative pulmonary administration of EOFAZ effectively alleviates the inflammation and oxidative stress， reduces lung cell apoptosis， and hinders the occurrence and development of emphysema. Its antioxidant mechanism is closely related to the up-regulation of Nrf2 and its downstream NQO1.

Identifiability and Predictability of Integer- and Fractional-Order Epidemiological Models Using Physics-Informed Neural Networks

We analyze a plurality of epidemiological models through the lens of physics-informed neural networks (PINNs) that enable us to identify multiple time-dependent parameters and to discover new data-driven fractional differential operators. In particular, we consider several variations of the classical susceptible-infectious-removed (SIR) model by introducing more compartments and delay in the dynamics described by integer-order, fractional-order, and time-delay models. We report the results for the spread of COVID-19 in New York City, Rhode Island and Michigan states, and Italy, by simultaneously inferring the unknown parameters and the unobserved dynamics. For integer-order and time-delay models, we fit the available data by identifying time-dependent parameters, which are represented by neural networks (NNs). In contrast, for fractional differential models, we fit the data by determining different time-dependent derivative orders for each compartment, which we represent by NNs. We investigate the identifiability of these unknown functions for different datasets, and quantify the uncertainty associated with NNs and with control measures in forecasting the pandemic.

Claudin 14/15 play important roles in early wallerian degeneration after rat sciatic nerve injury / 中华创伤杂志(英文版)

PURPOSE@#Wallerian degeneration (WD) is an antegrade degenerative process distal to peripheral nerve injury. Numerous genes are differentially regulated in response to the process. However, the underlying mechanism is unclear, especially the early response. We aimed at investigating the effects of sciatic nerve injury on WD via CLDN 14/15 interactions in vivo and in vitro.@*METHODS@#Using the methods of molecular biology and bioinformatics analysis, we investigated the molecular mechanism by which claudin 14/15 participate in WD. Our previous study showed that claudins 14 and 15 trigger the early signal flow and pathway in damaged sciatic nerves. Here, we report the effects of the interaction between claudin 14 and claudin 15 on nerve degeneration and regeneration during early WD.@*RESULTS@#It was found that claudin 14/15 were upregulated in the sciatic nerve in WD. Claudin 14/15 promoted Schwann cell proliferation, migration and anti-apoptosis in vitro. PKCα, NT3, NF2, and bFGF were significantly upregulated in transfected Schwann cells. Moreover, the expression levels of the β-catenin, p-AKT/AKT, p-c-jun/c-jun, and p-ERK/ERK signaling pathways were also significantly altered.@*CONCLUSION@#Claudin 14/15 affect Schwann cell proliferation, migration, and anti-apoptosis via the β-catenin, p-AKT/AKT, p-c-jun/c-jun, and p-ERK/ERK pathways in vitro and in vivo. The results of this study may help elucidate the molecular mechanisms of the tight junction signaling pathway underlying peripheral nerve degeneration.

Association of Visit-to-Visit Variabilities in Metabolic Factors with Chronic Kidney Disease in Chinese Adults Living in Shanghai / 生物医学与环境科学（英文）

Objective@#This study aimed to examine the association of visit-to-visit variabilities in metabolic factors with chronic kidney disease (CKD) in Shanghai community residents.@*Methods@#We used data from a cohort study of community residents who participated in three examinations in 2008, 2009, and 2013, respectively. Fasting plasma glucose (FPG) level, blood pressure (BP), and lipid levels were determined in 2,109 participants at all three visits, and CKD was evaluated between the second and the third visits. Visit-to-visit variabilities in metabolic factors were described by coefficients of variation (CV) at three visits. A variability score was calculated by adding the numbers of metabolic factors with a high variability defined as the highest quartile of CV. CKD was defined as the estimated glomerular filtration rate < 60 mL/min per 1.73 m @*Results@#A total of 200 (9.5%) participants had CKD at the third visit. Compared with the lowest quartile of CV, the highest quartile was associated with a 70% increased risk of CKD for FPG [odds ratio, @*Conclusion@#The visit-to-visit variabilities in metabolic factors were significantly associated with the risks of CKD in Shanghai community residents.

Clinical characteristics and pathogenesis of sleep disorder in patients with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Post-traumatic stress disorder(PTSD) caused by various natural disasters and man-made events has gradually become the highlight of neuroscientists. Sleep disorders after PTSD can impair the effect of treatment and affect the patient's prognosis. In addition, treatment for sleep problems can be effective in improving outcomes for people with PTSD, which indicates that it is significant to pay attention to sleep disorders after PTSD. However, current studies have focused more on the incidence of PTSD and severity of related symptoms after a traumatic event, and less on the occurrence and mechanism of sleep disorders after PTSD. A number of articles on stress and sleep disorders published in recent years provide reliable clues to understand the probable mechanisms of sleep disorders after PTSD. After summarizing the latest research results, this article finds that the occurrence of sleep disorder after PTSD may be related to the changes of connectivity between insula, hippocampus and medial-prefrontal cortex. Apart from that, decline in the mean phase difference of slow spindles in PTSD patients may reflect pathological changes in the thalamic cortical circuit, which may contribute to the objective diagnosis of PTSD and the development of sleep-focused interventions. This paper provides a systematic review of changes in sleep characteristics and possible neural circuitry mechanisms after PTSD from clinical and basic perspectives, which may provide potential directions for future researches on the pathological mechanism of sleep disorders after PTSD and screening novel intervention targets.

Influence of the arrangement of vacuum chuck holes on the transmittance wavefront of large-aperture KDP in single-point diamond turning.

Serious edge effects of potassium dihydrogen phosphate (${{\rm KH}_2}{{\rm PO}_4}$KH2PO4, KDP) manufactured using single-point diamond turning (SPDT) often result in disqualification of the transmittance wavefront for high-power laser systems. In this paper, based on the theoretical analysis of sucker hole configuration and the pressure distribution law under the vacuum chuck condition of crystal elements, the influence of sucker hole configuration on the transmittance wavefront root-mean-square gradient (GRMS) is verified through fly-cutting experiments. By adopting the newly designed vacuum chuck, the vacuum-chucking quality is effectively improved, and the edge effect is accordingly suppressed in the SPDT. Moreover, the accuracy of the transmittance wavefront GRMS has an improvement of about 25% under the same processing parameters.

Single-cell Transcriptome Analysis Indicates New Potential Regulation Mechanism of ACE2 and NPs signaling among heart failure patients infected with SARS-CoV-2

BackgroundCOVID-19 patients with comorbidities such as hypertension or heart failure (HF) are associated with poor clinical outcomes. Angiotensin-converting enzyme 2 (ACE2), the critical enzyme for SARS-CoV-2 infection, is broadly expressed in many organs including heart. However, the cellular distribution of ACE2 in the human heart, particularly the failing heart is unknown. MethodsWe analyzed single-cell RNA sequencing (scRNA-seq) data in both normal and failing hearts, and characterized the ACE2 gene expression profile in various cell subsets, especially in cardiomyocyte subsets, as well as its interaction with gene networks relating to various defense and immune responses at the single cell level. ResultsThe results demonstrated that ACE2 is present in cardiomyocytes (CMs), endothelial cells, fibroblasts and smooth muscle cells in the heart, while the number of ACE2-postive (ACE2+) CMs and ACE2 gene expression in these CMs are significantly increased in the failing hearts. Interestingly, both brain natriuretic peptides (BNP) and atrial natriuretic peptide (ANP) are significantly up-regulated in the ACE2+ CMs. Further analysis shows that ANP, BNP and ACE2 may form a negative feedback loop with a group of genes associated with the development of heart failure. To our surprise, we found that genes related to virus entry, virus replication and suppression of interferon-gamma (IFN-{gamma}) signaling are all up-regulated in CMs in failing hearts, and the increases were significantly higher in ACE2+ CMs as compared with ACE2 negative (ACE2-) CMs, suggesting that these ACE2+ CMs may be more vulnerable to virus infection. Since ACE2 expression is correlated with BNP expression, we further performed retrospective analysis of the plasma BNP levels and clinic outcome of 91 COVID-19 patients from a single-center. Patients with higher plasma BNP were associated with significantly higher mortality rate and expression levels of inflammatory and infective markers such as procalcitonin and C-reactive protein. ConclusionIn the failing heart, the upregulation of ACE2 and virus infection associated genes, as well as the increased expression of ANP and BNP could facilitate SARS-CoV-2 virus entry and replication in these vulnerable cardiomyocyte subsets. These findings may advance our understanding of the underlying molecular mechanisms of myocarditis associated with COVID-19.

Investigation of attitudes toward death and hospice care in nursing students before internship / 中华医学教育探索杂志

Objective:To investigate nursing students' attitudes toward death and hospice care before they start clinical practice, analyze the correlation between the two attitudes and compare their differences in junior and regular nursing college students.Methods:A cross-sectional study was adopted to investigate the attitudes toward death and hospice care in 232 senior nursing students at school. Instruments included the Chinese version of the Death Attitude Profile-Revised (DAP-R) and the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale-Form B (FATCOD-B). Pearson correlation analysis and independent t-test were used to analyze the data.Results:The mean scores of the 5 dimensions of death attitude were neutral acceptance (4.10±0.43), fear of death (2.76±0.66), death avoidance (2.73±0.74), approach acceptance (2.61±0.58), and escape acceptance (2.48±0.75), respectively. The total score of hospice care attitude was (107.63±8.45), which was negatively correlated with fear of death ( r=-0.247, P<0.01), death avoidance ( r=-0.278, P<0.01), and escape acceptance ( r=-0.145, P<0.05) scores and positively correlated with neutral acceptance score ( r=0.405, P<0.01). The death avoidance score of regular nursing college students was significantly lower than that of junior nursing college students ( t=-2.043, P<0.05), and the hospice care attitude score of regular nursing college students was significantly higher that of junior nursing college students ( t=2.639, P<0.01). Conclusion:There is a big room to improve nursing students' attitudes toward death and hospice care. Strengthening end-of-life care education is imperative.

Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in CommunityDwellers With Hypertension

Background@#Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking.We aimed to assess the performance of hemoglobin A1c (HbA1c) and its cut-off point in detecting diabetes in the abovementioned population. @*Methods@#Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the goldstandard for confirming diabetes. @*Results@#The areas under the ROC curves for HbA1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P = 0.01). HbA1c ≤ 5.1% (32 mmol/mol) and ≥ 6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. @*Conclusions@#HbA1c could detect diabetes effectively in community-dwellers with hypertension.

Transcutaneous electrical acupoint stimulation for post-traumatic stress disorder: Assessor-blinded, randomized controlled study.

AIM: Transcutaneous electrical acupoint stimulation (TEAS) has the potential to alleviate post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether adding TEAS to sertraline or cognitive behavioral therapy (CBT) could improve the anti-PTSD efficacy. METHODS: In this randomized controlled trial, 240 PTSD patients (60 in each group) were assigned to receive simulated TEAS combined with sertraline (group A) or with CBT (group B), active TEAS combined with CBT (group C), or active TEAS combined with CBT plus sertraline (group D) for 12 weeks. The outcomes were measured using the Clinician-Administered PTSD Scale, PTSD Check List-Civilian Version, and 17-item Hamilton Rating Scale for Depression. RESULTS: While PTSD symptoms reduced over time in all patients, groups C and D had markedly greater improvement in both PTSD and depressive measures than groups A and B in all post-baseline measurement points, with moderate to very large effect sizes of 0.484-2.244. Groups C and D also had a significantly higher rate than groups A and B on clinical response (85.0% and 95.0% vs 63.3% and 60.0%, P < 0.001) and on remission (15.0% and 25.0% vs 3.3% and 1.7%, P < 0.001). The incidence of adverse events was similar between groups A and D and between groups B and C. CONCLUSIONS: Additional TEAS augments the anti-PTSD and antidepressant efficacy of antidepressants or CBT, without increasing the incidence of adverse effects. TEAS could serve as an effective intervention for PTSD and comorbid depression. This trial was registered with www.chictr.org (no.: ChiCTR1800017255).

Current status of geriatric nursing competence of clinical nurses in grade A tertiary hospital in Guangdong Province and related influencing factors / 中国实用护理杂志

Objective@#To investigate the current status and influencing factors of geriatric nursing competence of clinical nurses from grade A tertiary hospitals in Guangdong Province, and provide basic materials and evidence-based reference for the set of suitable allocation of geriatric nursing competence training plan.@*Methods@#By convenience sampling, a total of 2 067 clinical nurses from 40 grade A tertiary hospitals in 16 prefecture-level cities in Guangdong Province were investigated with general information questionnaire and self-made geriatric nursing competence scale for clinical nurses.@*Results@#The item average score was 2.30±0.71. Among three domains, professional literacy scored the highest, followed by professional practice and professional development. Among ten sub-domains, the top three scored were law and ethic, critical thinking and safe management while the bottom three were coaching and mentoring, professional learning, research and innovation. Multiple linear regression showed that the influencing factors of geriatric nursing competence were nursing age (B=0.011, 95%CI 0.006-0.015, P<0.01), professional title (B=0.031, 95%CI 0.002-0.066, P<0.05), interest in aged care (B=0.214, 95%CI0.179-0.250, P<0.01) and experience regarding geriatric specialized or professional nurses qualification training(B=0.250, 95%CI 0.152-0.349, P<0.01).@*Conclusions@#The geriatric nursing competence of clinical nurses from grade A tertiary hospital in Guangdong Province is in the middle level. Interventions to improve the professional development competence of clinical nurses is thus much needed. Hospital managers should establish the talent team according to geriatric nursing competence of clinical nurses, and take related training.

Current status of geriatric nursing competence of clinical nurses in grade A tertiary hospital in Guangdong Province and related influencing factors / 中国实用护理杂志

Objective To investigate the current status and influencing factors of geriatric nursing competence of clinical nurses from grade A tertiary hospitals in Guangdong Province, and provide basic materials and evidence-based reference for the set of suitable allocation of geriatric nursing competence training plan. Methods By convenience sampling, a total of 2 067 clinical nurses from 40 grade A tertiary hospitals in 16 prefecture-level cities in Guangdong Province were investigated with general information questionnaire and self-made geriatric nursing competence scale for clinical nurses. Results The item average score was 2.30 ± 0.71. Among three domains, professional literacy scored the highest, followed by professional practice and professional development. Among ten sub-domains, the top three scored were law and ethic, critical thinking and safe management while the bottom three were coaching and mentoring, professional learning, research and innovation. Multiple linear regression showed that the influencing factors of geriatric nursing competence were nursing age ( B=0.011, 95% CI 0.006-0.015, P＜0.01), professional title ( B=0.031, 95% CI 0.002-0.066, P＜0.05), interest in aged care ( B=0.214, 95% CI 0.179-0.250, P＜0.01) and experience regarding geriatric specialized or professional nurses qualification training( B=0.250, 95% CI 0.152-0.349, P＜0.01). Conclusions The geriatric nursing competence of clinical nurses from grade A tertiary hospital in Guangdong Province is in the middle level. Interventions to improve the professional development competence of clinical nurses is thus much needed. Hospital managers should establish the talent team according to geriatric nursing competence of clinical nurses, and take related training.

Effect of long-chain non-coding RNA AL136359.1 on the proliferation and migration of cholangiocarcinoma cells by up-regulating the expression of AKR1B10 / 中国医师杂志

Objective To detect the expression of AL136359.1 in cholangiocarcinoma tissues and cells and analyze its effect on proliferation and migration of cholangiocarcinoma cells.Methods The expression of AL136359.1 in 8 cholangiocarcinoma tissues and 4 cholangiocarcinoma cell lines (QBC939,RBE,HCCC-9810 and TFK-1) was detected by real-time quantitative PCR (qRT-PCR).Transfection of plasmid carrying AL136359.1 in the cholangiocarcinoma cell line with the lowest expression level of AL136359.1 were used to increase the expression of AL136359.1,and the transfection efficiency was verified by qRT-PCR.qRT-PCR and Western blot were used to detect the expression of AKR1 B10 at mRNA and protein levels.The cell counting kit (CCK-8) and transwell migration assay were used to detect the effect of high expression of AL136359.1 on the proliferation and migration ability of cholangiocarcinoma cells.Results The expression of AL136359.1 in cholangiocarcinoma tissues (0.41± 0.05) was significantly lower than that in adjacent tissues (2.94 ± 0.44,P ＜ 0.01).The expression of AL136359.1 in cholangiocarcinoma cells was significantly lower than that in human normal cholangioepithelial cells (P ＜0.01),and the QBC939 cells had the lowest expression (P ＜ 0.01).High expression of AL136359.1 caused an increase in the expression of AKR1 B10 at mRNA and protein levels (P ＜ 0.01).High expression of AL136359.1 could significantly inhibit the proliferation and migration of cholangiocarcinoma cells (P ＜0.01).Conclusions The expression of AL136359.1 were decreased in cholangiocarcinoma tissues and cell line.The high expression of AL136359.1 could up-regulate the mRNA expression of AKR1B10 gene,which was involved in inhibiting the proliferation and migration of QBC939 cells.