Objective To explore the effects of botulinum toxin type A (BTX-A) on the F-waves of the tibial nerve and the walking ability of stroke patients.Methods Twenty stroke patients with spastic hemiplegia of a lower limb were randomly divided into experimental and control groups with 10 patients in each group.All received four weeks of conventional rehabilitation,including walking training,balance training and muscle strength training.In the experimental group,a total of 300 IU of BTX-A was injected into the gastrocnemius (200 IU) and soleus muscles (100 IU)before the start of routine rehabilitation,guided by using the electrical stimulation.Muscle tone was assessed using the modified Ashworth scale(MAS).Walking ability was assessed with the timed up and go test (TUGT) and a 10 m free walking test.F-wave parameters were recorded in the tibial nerve before,two weeks and four weeks after the injection.Results In the experimental group there was a significant difference in F-wave amplitude between those recorded before treatment and after two weeks of treatment.The control group showed no statistically significant difference.In experimental group there was also a statistically significant difference in triceps muscle tension before and after treatment which was not observed in the control group.Walking ability improved significantly in both groups.Conclusions Local injection of BTX-A into the lower limbs can reduce the F-wave amplitudes of spinal cord motor neurons.BTX-A injection combined with rehabilitation training can significantly improve the walking ability of stroke patients.

Objective To investigate the effect of PBL method in the pathogen and immunology teaching. Methods PBL teaching was practised in trial group,while LBL teaching was practiced in control group.The writers made an analysis of this teaching by way of questionnaire and exam. Results Many students by PBL teaching accept PBL teaching Method,and improve their self-study ability,understanding ability,analyzing ability and so on. Conclusion PBL teaching method is much better than LBL teaching method,and can improve the quality of pathogen and immunology teaching.

Objective To explore any effect of proprioceptive neuromuscular facilitation (PNF) on the proprioception and balance of patients with knee osteoarthritis (KOA).Methods Forty patients with KOA were randomly divided into an experimental group (EG) and a control group (CG),each of 20.The PNF techniques of isotonic combined contraction,and rhythmic stable and dynamic reversal were applied in the EG,while the CG received quadriceps muscle strength training.Knee proprioception was evaluated using knee angle reconstruction experiments,and balance ability was measured using the one leg standing test (OLS) and the five times sit to stand test (FTSST).Results The errors in active and passive knee angle reconstruction at 30°,60° and 110° all improved significantly in the EG,but not in the CG.After the treatment,the OLS and FTSST results improved significantly in the EG,but only the OLS results improved significantly in the CG,not the FTSST times.Even so,the average OLS time in the EG was significantly longer than that of the CG after the training.Conclusion Proprioceptive neuromuscular facilitation can improve the proprioception and balance of persons with knee osteoarthritis.

Objective To study the effects of compound preparations which contain docosahexenoic acid (DHA),soybean lecithin,and vitamin A on memory ability of children and to compare the difference between two compound preparations that contain DHA from marine algae and from fish oil.Methods Totally 160 11-12-year-old healthy children who were studying in a primary school in Baoshan District of Shanghai were enrolled in this study.All the subjects signed the informed consent form.Subjects were randomly divided into three groups with random numbers:marine algae DHA group(n=53),fish oil DHA group(n=53),and control group(n=54).Subjects in the marine algae DHA group were given compound preparation which contained DHA form marine algae,soybean lecithin,and vitamin A;subjects in fish oil DHA group were given compound preparation which contained DHA form fish oil,soybean lecithin,and vitamin A.The dose of DHA(200 mg DHA per capsule)and other components in the two groups was equal.Subjects in the control group were given a placebo with same appearance.The trial lasted 30 days.Each subject took a capsule per day.Immediately before and after the trial,subjects were tested by using the clinical memory scale compiled by the Institute of Clinical Psychology of the Chinese Academy of Sciences.Results Before the trial.there was no difference amongthree groups in terms of all items of clinical memory scale or memory quotient(all P>0.05).After the trial,except for associative learning(both P>0.05),the other items of the clinical memory scale and memory quotient in both marine algae DHA group and fish oil DHA group were significantly higher than those of control group(all P<0.05).No significant difference was noted between the marine algae DHA group and fish oil DHA group for all items of the clinical memory scale or memory quotient(all P>0.05).Conclusions DHA compounds can impreve the memory ability of children.DHAs with different sources have similar effect on memory ability.

Objective To analyze the distribution and antimicrobial resistance situation of pathogens isolated from blood culture to provide the scientific basis for the accuratel use of antibacterial drugs and preventing and controlling nosocomial acquired blood‐stream infection .Methods The US BACTEK‐FK automatic blood culture instrument and the French VITEK 2 COMPACT auto‐matic bacteria identification/susceptibility system were used to conduct the culture ,identification of blood culture isolated bacterial strains and drug susceptibility test .The results of drug susceptibility test were judged by adopting the 2011 criteria of the Clinical Laboratory and Standards Institute(CLSI) .Results The main isolated bacteria from blood culture for the recent three years were E coli ,staphylococcus aureus and klebsiella pneumonia bacteria ,coagulase negative staphylococcus(CNS) ,etc .The proportions of hos‐pital‐acquired bloodstream infections during these period were 42 .2% ,46 .9% and 54 .1% respectively .The detection rate of methi‐cillin‐resistant staphylococcus aureus (MRSA) was 18 .8% ,which of multiple drug resistant acinetobacter baumannii (MDRAB) was 42 .9% ,which of producing extended spectrum beta lactamase (ESBLs) in E .coli and klebsiella pneumoniae were 71 .8% and 69 .8% respectively .Conclusion The bloodstream infections pathogens in this hospital are mainly Enterobacteriaceae bacteria ,the proportion of hospital‐acquired bloodstream infections increases year by year ;the detection rate of multi‐drug resistant Acinetobact‐er baumanni (MDRAB) is higher ,clinic should pay more attention to the change of blood culture pathogens and their drug resist‐ance trend ,meanwhile nosocomial bloodstream infection should be prevented and controlled .

OBJECTIVE To identify the chemical components of Shenbai Jiedu Decoction(SBJDD),a traditional Chinese medi-cine(TCM)prescription clinically used for the treatment of colorectal adenoma(CRA),and explore the potential mechanism of SBJDD preventing and treating CRA carcinogenesis.METHODS An ultra-high performance liquid chromatography-time of flight-mass spectrometry(UPLC-Q-TOF-MS)method was established to detect the chemical components in the decoction of SBJDD and the plas-ma samples of rats after administration with SBJDD.Based on the network pharmacological method,SBJDD was screened for the poten-tial active ingredients at different stages of CRA carcinogenesis,and the mechanism of the anti-cancer effect of SBJDD was explored.In vitro experiments were also carried out to verify the mechanism of anti-colorectal cancer(CRC)action of SBJDD.RE-SULTS The detection data of UPLC-Q-TOF-MS showed that 152 components were found from SBJDD water extraction.41 chemical compounds were identified in plasma samples from rats administrated with SBJDD.Network pharmacology analysis indicated that during the CREI stage,the potential active ingredients in SBJDD,including epiberberine,and kushenol H,might affect target proteins such as PIK3CA,MAPK3 and PIK3CB.This,in turn,can influence signaling pathways like PI3K-AKT and Ras signaling pathways,and regulate biological processes like protein phosphorylation,and signal transduction.During the CRA stage,the potential active ingredi-ents from SBJDD,such as 3,7-dihydroxycoumarin,palmatine,and kushenol A,might affect target proteins such as AKT and EGFR.This can regulate the negative regulation of apoptotic process,and positive regulation of cell proliferation,and modify HIF-1,and Rap1 signaling pathways.During the progression of CRA carcinogenesis,potential active ingredients such as 3,7-dihydroxycouma-rin may interact with TP53,and impact the PI3K-AKT,and Thyroid hormone signaling pathways to regulate biological processes,in-cluding positive regulation of transcription from RNA polymerase Ⅱ promoter,and negative regulation of apoptotic process.In the CRC stage,core ingredients like p-coumaric acid may bind with proteins such as PRKCB.This binding may impact the signaling pathways that negatively affect EGFR tyrosine kinase inhibitor resistance,and PI3K-AKT signaling pathways.Additionally,it may regulate bio-logical processes,including negative regulation of apoptotic process,signal transduction,and protein phosphorylation.In vitro experi-ment results indicated that SBJDD inhibited the proliferation of HT29 cells and suppressed the expression of EGFR and PKC proteins.CONCLUSION The UPLC-Q-TOF-MS method is established to effectively separate the chemical constituents in SBJDD,which are mainly composed of alkaloids,organic acids and flavonoids components.Components from SBJDD dock with different targets during the carcinogenesis process of CRA and regulate cancer-related signaling pathways to exert therapeutic effects.

Objective: To investigate the clinical significance of tumor associated macrophages (TAM) in multiple myeloma (MM) and the relationship with angiogenesis and immunosuppression. Methods: Seventy cases of MM patients diagnosed from August 2015 to June 2017 were enrolled in the study as experimental group, 20 cases of benign hematological diseases (13 with iron deficiency anemia and 7 with megaloblastic anemia) patients as control group. Immunohistochemical method was used to detect the expression of CD163, CD34 and VEGF in bone marrow samples, and flow cytometry was used to detect the proportion of regulatory T cell (Treg cells), ELISA was used to detect the level of IL-10, and the clinical features were analyzed. Results: ①Among the 70 patients, there were 31 males and 39 females with a median age of 65 (50~78) years old. TAM infiltration density, microvascular density (MVD), VEGF expression level, Treg ratio and IL-10 level in bone marrow samples of 70 MM patients were significantly higher than those of benign hematological diseases (P<0.05). ②In the MM group, the above indexes of the patients with disease stabilized (15 cases) were lower than those of the newly diagnosed group (35 cases) and the relapse refractory group (20 cases) (P<0.05), those of relapse refractory group were higher than those of newly diagnosed group (P>0.05). ③Of the 35 newly diagnosed MM patients, 27 completed 4 courses of treatment. In the effective group (15 cases), the TAM infiltration density after treatment was significantly lower than that before treatment, the difference was statistically significant[(20.20±7.66) vs (28.87±11.97), t=2.362, P=0.025]; while in the ineffective group of 12 cases, the difference of the TAM infiltration density before and after treatment was not statistically significant[(42.00±13.76) vs (48.25±13.59), t=1.119, P=0.275]. ④TAM infiltration density in the effective group after bortezomib treatment (21 cases) were lower than those in the non-bortezomib treatment group (18 cases)[(16.52 ±4.26) vs (19.27 ±5.82), t=1.662, P=0.170]. ⑤The TAM infiltration density in MM patients was positively correlated with MVD, VEGF expression level, Treg cell ratio and IL-10 level (P<0.001). Conclusion The infiltration of TAM in the microenvironment of MM, which may promoting angiogenesis and inhibiting immune response, is related to the occurrence, development, therapeutic effect and drug resistance of MM.

Objective:To understand the changes of serum specific antibodies after human infection with 2019 novel coronavirus (2019-nCoV).Methods:A total of 1 705 serum samples from 514 confirmed cases and asymptomatic infected cases (including recovered, hospitalized, and newly infected cases) of Coronavirus Disease 2019 (COVID-19) at different times were collected in Sichuan province. Chemiluminescence immunoassay (CLIA) was used to detect IgM and IgG antibodies. The variations of concentration of IgM and IgG were analyzed by statistical methods. SPSS26.0 was used for statistical analysis of IgM and IgG antibody detection data to reveal the dynamic changes of IgM and IgG antibodies.Results:A total of 352 confirmed cases and 162 asymptomatic infected cases were included. 92.75%-100% of infected cases were positive for IgG antibodies after 8-149 days from the date of diagnosis (or tested-positive for 2019-nCoV nucleic acid). More than 60% of the infected cases were still positive for IgG antibodies after 360 days. However, the signal-to-cutoff (S/CO) value of IgG antibodies decreased over time. Consecutive detecting serum of 15 infected cases, the positive rate of specific IgM and IgG antibodies was 100% in 8-14 days after diagnosis (or tested-positive for 2019-nCoV nucleic acid). IgM antibodies turned negative after 120 days. The S/CO value of IgM antibodies was observed to vary with disease course. During 0-7 days and 23-89 days after diagnosis (tested-positive for 2019-nCoV nucleic acid), there were statistically significant difference in the positive rate of IgM antibodies between confirmed cases and asymptomatic cases ( P<0.05). After 150 days, the positive rate of IgG antibodies in confirmed cases group was higher than that in asymptomatic cases group. The difference is statistically significant ( χ2=7.65, P=0.006). Conclusions:The changes of IgM and IgG antibodies levels in serum of different types of 2019-nCoV infected cases over time are different.

Objective: To analyze the detection rate of sleep problems such as sleep delay and deficiency in preschool children in the middle and lower reaches of the Yangtze River in China,and to provide the reference for the standard of sleeping mode among preschool students. Methods: From October to November 2017, a questionnaire survey was conducted among 27 200 preschool children in 11 cities in Hubei, Anhui and Jiangsu provinces in the middle and lower reaches of the Yangtze River in China. Epidemiology of sleep delays, deficiencies and sleep patterns in preschool children was described. Results: The detection rate of sleep problems in preschool children in the middle and lower reaches of the Yangtze River was 15.3%. Taking the length of sleep and bedtime as the main analysis points, it was found that the average sleeping time point of each age group was 21:31, and the detection rate of bedtime delay was 86.5%. The average length of sleep was (10.60±1.12) hours. The detection rate of sleep deprivation in preschool children was 15.7%. Sleep delay was positively correlated with girls, age increase and parents’ higher educational level (P<0.05), and negatively correlated with living in the city, non-only child and bedroom without TV (P<0.01) .The detection rate of sleep deprivation was positively correlated with children of high age group (4yearold group：OR=1.32，95%CI=1.19-1.46；5-year-old group：OR=2.10，95%CI=1.91-2.32；6-year-old group：OR=2.47，95%CI=2.20-2.77)(P<0.01), and negatively correlated with no TV in bedroom (OR=0.91，95%CI=0.84-0.98) and no light in sleep (OR=0.87，95%CI=0.78-0.97)(P<0.05). Conclusion Preschool children sleep delay and sleep deprivation and other sleep problems are more prominent, affected by family environment and other factors.

Objective:To explore the safety and efficacy of chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory acute B-cell lymphoblastic leukemia (B-ALL) with T315I mutation.Methods:The clinical data of a patient with relapsed/refractory B-ALL with T315I mutation who underwent CAR-T therapy in the Second Affiliated Hospital of Anhui Medical University was analyzed, and the related literature was reviewed.Results:The patient was a 34-year-old man. He was diagnosed with chronic myelogenous leukemia (CML) in January 2017 and started to take imatinib orally. However, the primary affection transformed to B-ALL 4 months later. Because of the E355G gene mutation, the treatment drug was adjusted to dasatinib, and induction chemotherapy was given at the same time. The sequential consolidation chemotherapy was given for 3 times after complete remission (CR). After half a year of remission, T315I mutation was detected and re-induced chemotherapy was given, but ineffective. The patient was treated with CAR-T 3 days after FC regimen (fludarabine 30 mg/m 2 per day, day 1 to day 3; cyclophosphamide 200 mg/m 2, day 1 to day 3). The number of CD19 CAR-T was 1.0×10 9, 98% activity degree. Grade 1 cytokine-releasing syndrome appeared after infusion, and was resolved after symptomatic treatment. No serious adverse reactions were observed. CR was achieved half-month after CAR-T treatment, and umbilical cord blood transplantation was successfully performed 1 month later. At the last follow-up, the relapse-free survival time of the patient was 396 days. Conclusion:CAR-T therapy may be a new, safe and effective therapy for patients with relapsed/refractory B-ALL with T315I mutation.