Objective To observe the effect of comprehensive rehabilitation on POEMS syndrome during sequel period. Methods Two cases of POEMS syndrome with multiple peripheral nerve injury as the main manifestation received physical therapy, occupational therapy, acupuncture, surface electromyography biofeedback and other comprehensive rehabilitation treatment. Results After treatment, the muscle strength, trunk balance, standing balance ability, activities of daily living (ADL) improved. The score of Berg Balance Scale increased from 18 to 28 in the first case, the modified Bathel Index increased from 55 to 70 in the second case. Conclusion Comprehensive rehabilitation can improve the function of patients with POEMS syndrome during sequel period, and surface electromyography biofeedback plays an im-portant role.

Objective To study the influence of different doses of remifentanil on postoperative hemodynam -ics in patients undergoing laparoscopic total hysterectomy.Methods Ninety patients underwent laparoscopic total hysterectomy in Weihai Municipal Hospital were selected as the subjects ,and they were divided into A group (0.2μg/kg· min remifentanil),B group(0.3μg/kg· min remifentanil),C group (0.5μg/kg· min remifentanil) according to the random number table method ,with 30 cases in each group.The relative operative indicators (including operation time,anesthesia time,extubation time and analgesia time ) of the three groups were compared ,and compared the heart rate (HR) and mean arterial pressure (MAP) in the three groups at different stages (T0:preoperation,T1:immedi-ately after operation,T2:one day after operation,T3:three days after operation).The adverse reactions were recorded and compared.Results There were no statistically significant differences on relative operative indicators among the three groups (F＝1.278,1.346,0.987,2.232,all P＞0.05).The levels of HR and MAP in A group ,B group and C group at T1 were ( 94.68 ±8.51) times/min and (105.84 ±11.37 ) mmHg, ( 81.82 ±9.17 ) times/min and (97.14 ±9.02)mmHg,(75.24 ±8.29)times/min and (82.39 ±10.87)mmHg,respectively.The levels of HR and MAP in A group were higher than those in B group and C group (t＝5.630,3.283,8.962,8.165,all P＜0.05).The levels of HR and MAP in B group were higher than those in C group (t＝2.915,5.720,all P＜0.05).The HR and MAP of A group at T1 were higher than those of T0,T2 and T3 (t＝7.118,6.249,6.977,all P＜0.05,t＝3.632, 3.728,3.717,all P＜0.05).The HR and MAP of C group at T1 were lower than those of T0,T2 and T3 (t＝2.060, 2.043,2.068,all P＜0.05,t＝5.429,5.549,5.341,all P＜0.05).There were no statistically significant differences in HR and MAP of B group at T0,T2 and T3 (t＝1.408,0.529,1.106,all P＞0.05,t＝0.480,0.430,0.437,all P＞0.05).There was no statistically significant difference in the total incidence of adverse reactions among the three groups (χ2＝3.069,P ＞0.05).Conclusion Different doses of remifentanil have great impact on postoperative hemodynamics undergoing laparoscopic total hysterectomy ,while the dose of 0.3μg/kg· min is stable,which is worthy of attention.

Objective:To optimize the blending method of Shuanghuanglian injection, and to investigate its stability in different solvents (0.9% sodium chloride injection, 5% glucose injection, 10% glucose injection, glucose and sodium chloride injection). Methods:By using orthogonal test to optimize the best dissolution method of Shuanghuanglian injection By measuring the content change of insoluble particles, pH value and principal components (baicalin, forsythione, chlorogenic acid) in the finished products to investigatethe stability of Shuanghuanglian injection in different solvents. Results:The optimal blending method of Shuanghuanglian injection was to add 5 ml sterilized water for injection into the vial and oscillate at 1 200 r/min frequency for 5 min. The main constituents of Shuanghuanglian injection were stable in 8 h in the infusion of four kinds of finished products. Insoluble particles in 0.9% sodium chloride infusion and 5% glucose infusion met the requirements within 8 h, and insoluble particles in 10% glucose infusion and 6 h glucose and sodium chloride infusion met the requirements. The pH value of 0.9% sodium chloride infusion within 8 h met the optimal requirements of the best compatibility, 5% glucose infusion within 2 h met the requirements, and 4 h sodium chloride infusion met the requirements of the best compatibility. Conclusion:This study optimized the best preparation method of Shuanghuanglian (freeze-dried) for injection. Sodium chloride injection should be used as the solvent to prepare finished infusion in clinical application, and 5% glucose injection should be prepared just before use.

Objective To assess the safety and feasibility of video electroencephalographic (VEEG) monitoring in preterm infants and critically ill neonates in neonatal intensive care unit (NICU). Method From December 2017 to June 2018, high risk infants were prospectively enrolled and received VEEG monitoring in our NICU. Their basic information, adverse events and disturbances of any procedure during VEEG monitoring were collected by specially-trained nurses. Result A total of 245 times of VEEG were recorded. The average gestational age (GA) was (32.1 ± 3.6) weeks, the birth weight (BW) was (1879 ± 757) g, the corrected GA (cGA) at VEEG monitoring was (33.8±3.3) weeks, and the average weight at VEEG monitoring was (2008±716) g. The earliest cGA at VEEG monitoring was 25+5 weeks, and the lowest weight at VEEG monitoring was 520 g. The average monitoring duration was (4.9±2.4) h, ranging from 3 to 20 hours. During VEEG monitoring, 80 cases (32.7％) received noninvasive ventilation, 43 cases (17.6％) mechanical ventilation. The adverse events during electrodes placement were oxygen desaturation in 8(3.3％) cases. During VEEG monitoring, local skin erythema were found in 4 cases (1.6％), and electrodes displacement in 2(0.8％) cases. The disturbances of any clinical procedures were reported in 18(7.3％) cases. No severe adverse events such as displacement of endotracheal tube nor events requiring cardiopulmonary resuscitation occurred during VEEG monitoring. Conclusion It is feasible and safe for trained NICU nurses to place electrodes for high risk neonates.

Objective:To study the clinical application and complications of umbilical arterial catheterization (UAC) in premature infants.Methods:From January 2021 to December 2022, premature infants with UAC successfully inserted in NICU of our hospital were enrolled. According to birth weight (BW), the infants were assigned into three groups: <1 000 g, 1 000~1 499 g and ≥1 500 g. The perinatal data, UAC usage, UAC-related complications and risk factors of UAC-related complications were retrospectively analyzed.Results:A total of 39 premature infants received UAC, with gestational age 29.3(27.3, 30.4) weeks and BW 1 100 (900, 1 310) g. The insertion length (IL) of UAC was calculated using the average value of two formulas: a, IL (cm) =4×BW (kg) +7; and b, IL(cm) =3×BW (kg)+9. The accuracy of tube end position was determined using chest/abdomen radiography. 30(76.9%) cases had accurate position, 6(15.4%) had higher position and 3(7.7%) had lower position. The proportion of appropriately positioned tube end in <1 000 g, 1 000~1 499 g and ≥1 500 g groups were 80.0%, 76.5% and 71.4%, respectively, without statistically significant differences ( P>0.05) .No significant differences existed among the three groups in UAC duration and UAC routinely removal rate ( P>0.05). 9 cases (23.1%) of UAC were removed for specific reasons, including 4 cases of arterial spasm, 2 cases of withdrawal of treatment, 1 case of tube end displacement, 1 case of abdominal distension and 1 case of death. 21 cases received 1 U/ml heparin (0.9%NaCl solution) 0.5~1 ml/h arterial infusion. 23.8% (5/21) had hypernatremia and the level of sodium became normal after reducing the concentration of NaCl solution. Arterial vasospasm occurred in 4 patients with skin color changes of one side of the lower extremities. After UAC removal, the skin color returned to normal. Conclusions:UAC is helpful and safe for preterm infants, however, its complications should be alerted to.

OBJECTIVE: To investigate the mechanism by which conditioned medium of colorectal cancer cells promotes the formation of cancer-associated fibroblasts (CAFs). METHODS: Normal human colorectal fibroblasts (CCD-18Co cells) in logarithmic growth phase were treated with the conditioned media of colorectal cancer HCT116 cells (HCT116-CM) or Caco-2 cells (Caco-2-CM) alone or in combination with 300 nmol/L ERK inhibitor SCH772984. The expression levels of CAFs-related molecular markers were detected in the treated cells with real-time quantitative PCR (RT- qPCR) and immunofluorescence assay, and the changes in cell proliferation, colony formation and migration were assessed with RTCA, colony formation and wound healing assays; Western blotting was performed to detect the activated signaling pathways in the fibroblasts and the changes in CAFs formation after blocking of the signaling pathway. RESULTS: HCT116-CM and Caco-2-CM significantly upregulated mRNA expression levels of CAFs markers (including α-SMA, FAP, FN and TGF-β) in CCD-18Co cells, and strongly promoted fibroblast transformation into CAFs (P < 0.05). The two conditioned media also promoted the proliferation, colony formation and migration of CCD-18Co cells (P < 0.05) and significantly increased the levels of α-SMA protein and ERK phosphorylation in the cells (P < 0.05). The ERK inhibitor SCH772984 obviously inhibited the expression of α-SMA and the transformation of CCD-18Co cells into CAFs induced by the conditioned medium of colorectal cancer cells (P < 0.05). CONCLUSION Colorectal cancer cells may induce the formation of colorectal CAFs by activating the ERK pathway in the fibroblasts.
Humans ; Cancer-Associated Fibroblasts/metabolism* ; Culture Media, Conditioned/pharmacology* ; MAP Kinase Signaling System ; Caco-2 Cells ; Fibroblasts ; Signal Transduction ; Cell Proliferation ; Cell Line, Tumor ; Colorectal Neoplasms/genetics* ; Cell Movement

Objective To investigate the association between levels of serum alanine aminotransferase (ALT) and the risks of cardiovascular disease in Chinese. Methods A survey of 10 375 subjects aged 40 or older in Jiading District of Shanghai was performed using cluster sampling. All the subjects were recruited to undergo questionnaire interview, anthropometric measurements, and fasting blood sampling. A total of 8 877 participants were included in the final analyses, including 5 664 females and 3 213 males. The mean age of individuals was ( 58.68 ± 9.22)yearsinmenand(57.65±8.93)yearsinwomen(P＜0.01).10-yearriskforafirsthardatherosclerotic cardiovascular diseases (ASCVD) event was calculated. Results Increased ALT levels were associated with more unfavorable cardiovascular risk profiles and 10-year risk for ASCVD. Increased ALT levels were associated with the prevalence of diabetes mellitus in female participants, while in male participants the prevalence of diabetes mellitus appeared as a U-distribution. The prevalence of hypertension and hyperlipidemia were 66.04%, 52.74%and 64.49%, 47.63% respectively. Increased serum ALT was associated with higher prevalence of 10-year risk for ASCVD. As compared with participants in the first ALT quartile, the risks of 10-year risk for ASCVD were increased by 148%(OR＝2.48, 95%CI 1.78-3.45) and 139%(OR＝2.39, 95%CI 1.78-3.19), respectively in male and female participants. As compared with participants in the first ALT quartile, higher prevalence of 10-year risk for ASCVD were increased by 96%(OR＝1.96, 95%CI 1.30-2.95), while there was no significantly statistical difference in men. Conclusion A high-normal serum ALT level was significantly associated with an increased risk of the cardiovascular disease in middle-aged and elderly Chinese.

Objective To investigate the association of age at menarche with the risks of diabetes and metabolic syndrome ( MS) in adulthood in Shanghai community postmenopausal women. Methods A total of 10375 residents over 40 years in Jiading, Shanghai were identified by a cluster sampling method. After taking standardized questionnaire surveys, physical examinations, and biochemical parameters testing, we gathered their lifestyle and medicine information. A total of 4723 postmenopausal women were enrolled in the study. The population was divided into three groups according to age at menarche, and their risks of MS and diabetes in various groups were compared. Results After multivariate adjustment, postmenopausal women with a menarche age<15 years had a 29％increased risk of diabetes(95％CI 1.03-1.61) and a 45％ increased risk of MS(95％ CI 1.20-1.76) in adulthood, compared with those with menarcheal age at 15-18 years. Among the five components of MS, earlier age of menarche was associated with higher risks of hypertriglyceridemia, low high density lipoprotein-cholesterol, and central obesity. Conclusions In Shanghai Jiading community postmenopausal women, age at menarche is associated with the risk of diabetes and MS, independent of the body mass index in adulthood.

Danggui Buxuetang， derived from Clarifying Doubts about Damage from Internal and External Causes （Volume 2）： Treatise on Heat Injury to Stomach Qi（《内外伤辨惑论卷中·暑伤胃气论》） by LI Dongyuan in the Jin and Yuan dynasties， is a classic and famous formula for tonifying qi and generating blood that has been inherited and promoted by successive generations of medical practitioners and has been included in the "Catalogue of Ancient Classical Prescriptions （First Batch）" published by the National Administration of Traditional Chinese Medicine in 2018. The paper analyzed the historical origin， composition， dosage， processing， preparation， decocting， and taking methods， efficacy， and application of the classic formula Danggui Buxuetang by consulting ancient and modern literature and combining the key information examination principles of ancient classic prescriptions. A total of 604 pieces of information on relevant ancient literature were collected， including 186 ancient Chinese medical books， of which 40 （five in the Jin and Yuan dynasties， 19 in the Ming Dynasty， and 16 in the Qing Dynasty） had detailed records of composition， processing， and dosage. Danggui Buxuetang is mainly comprised of Astragali Radix and Angelicae Sinensis Radix. According to the ancient and modern dose conversion， there are 37.3-38.1 g of Astragali Radix and 7.5-7.6 g of Angelicae Sinensis Radix in the formula. Astragali Radix is preferably fried with honey and Angelicae Sinensis Radix with wine. Astragali Radix and Angelicae Sinensis Radix are decocted with 600 mL of water to 300 mL， and taken warm before meals. The main effect of this formula are described in ancient books as blood deficiency and fever， with symptoms of muscle fever， dryness and heat， irritability and thirst， red eyes and face， sleeplessness in daytime and night， and surging and feeble pulse which is weak under hard pressing， and it is a famous formula for replenishing qi and generating blood. Modern research shows that Danggui Buxuetang is commonly used in the treatment of various kinds of anemia， diabetic nephropathy， tumors， and cardiovascular and cerebrovascular diseases. The above research results can provide a reference for the subsequent development and research on the classic formula Danggui Buxuetang.

Objective : To investigate the neurobehavioral development of young children aged 24 to 60 months in Shunde and explore the factors influencing the development of young children and provide reference for the interven- tion of neurobehavioral development delays in young children． Methods : A retrospective cohort study was used to enroll the young children who were initially screened by the Pediatric Neuropsychological Developmental Scale (Pe- diatric Heart Scale) with a score of ≤85 was included in the study．With a score of ≤85，the young children might be at risk of developmental delays，and needed to be further diagnosed by the GESELL Developmental Diagnostic Scale，the basic information of the young children and their mothers at the time of birth were investigated，as well as basic information about the young children at the time of completing the GESELL Developmental Diagnostic Scale was collected. Results : A total of 271 young children were included，196 males and 75 females．Young children had the lowest developmental quotient (DQ) in the language domain among the five domains (P＜0. 001) ．Multiple lin- ear regression models showed : compared with girls，the language domain DQ of boys decreased by 5. 321 points (P = 0. 049，95% CI : －10. 620 －－0. 021) ，and the personal-social domain DQ decreased by 4. 474 points (P = 0. 023，95% CI : －8. 316 －－0. 631) ．Compared with young children via natural vaginal delivery (NVD) ，the gross motor domain DQ of young children via caesarean section ( CS) decreased by 4. 890 points (P = 0. 008，95% CI : - 8. 499 －－1. 281 ) ，the fine motor domain DQ decreased by 3. 373 points ( P = 0. 037，95% CI : －6. 532 - - 0. 213) ，the language domain DQ decreased by 7. 621 points (P = 0. 004，95% CI : －12. 826 －－2. 416) ，per- sonal-social domain DQ decreased by 6. 232 points (P = 0. 001，95% CI : －10. 006 －－2. 457) ．The results of bi- nary logistic regression models showed，compared with young children via NVD，the risk of gross motor domain retar- dation in young children increased ( OR = 1. 763，95% CI : 1. 003－3. 100) ，the risk of fine motor domain retardation increased ( OR = 2. 217，95% CI : 1. 235－3. 980) ，the risk of language domain retardation increased ( OR = 3. 306， 95% CI : 1. 080 －10. 124) . Conclusion Young children with suspected neurobehavioral delays were more likely to have delayed development in language domain than in other domains，boys had lower DQ in language domain and personal-social domain than girls，and the development of young children via CS was slower than that via NVD．Fo- cus should be on the language development of young children especially on the language and personal-social devel- opment of boys．Carefully chose delivery way．Focus should be placed on assessment of young children's comprehen- sive neurobehavioral development in early time.