To summarize Prof. ZHANG Zhiyuan's clinical experience in using large doses of Fuzi （Aconiti Lateralis Radix Praeparata）. The effect of Fuzi is based on its acrid and hot propoerties， warming and invigorating yang qi and running without guard. The application of large doses of Fuzi can be categorized into raw and processed， with common dosage ranging from 30 g to 60 g of raw Fuzi， and 15 g to 30 g， 30 g to 60 g of processed Fuzi. The quantity-effect relationship of the large dose of Fuzi is summarized as 15 g to 30 g of processed Fuzi could warm water， warm yang and eliminate timidity， as the treatment of asthma with deficiency cold phlegm， edema of yang deficiency， and panic and timidity of yang deficiency； 30 g to 60 g of processed Fuzi could tonify fire， warm the meridians and collaterals， assist yang to dispel cold and relieve pain， as the treatment of coldness in the limbs， abdominal pain， pain in the joints of the limbs， and loose stools due to deficient yang qi and exuberant internal yin cold； 30 g to 60 g raw Fuzi could restore yang to save from collapse， as the treatment of yang depletion after profuse sweating and vomiting. At the same time， different dosages of Fuzi were flexibly paired with other medicines， i.e.， 15 g to 30 g of processed Fuzi was paired with Mahuang （Ephedrae Herba） and Xixin （Asari Radix et Rhizoma） to assist yang to dispel coldness， 30 g to 60 g of processed Fuzi was paired with Baizhu （Atractylodis macrocephalae rhizoma） or Wuzhuyu （Euodiae Fructus） to warm yang and dispel dampness， and 30 g to 60 g of raw Fuzi was paired with Shanzhuyu （Corni Fructus） to tonify both yin and yang.

Objective:To translate the Illness Identity Questionnaire (IIQ) into Chinese and test its reliability and validity.Methods:The English version of IIQ was translated into Chinese and back-translated according to the Brislin model. The item of the Chinese version was determined after cross-cultural adaptation and pre-experiment. A total of 368 patients with IBD treated in the First Affiliated Hospital with Nanjing Medical University from September 2022 to March 2023 were selected for a questionnaire survey to evaluate the reliability and validity of the questionnaire.Results:The Chinese version of IIQ contained 24 items in four dimensions. Four common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 64.025%. Confirmatory factor analysis showed that each fitting index of the modified model was within the acceptable range. The Cronbach's α coefficients of rejection, acceptance, engulfing, and enrichment in Chinese IIQ were respectively 0.780, 0.800, 0.921, and 0.917. The split-half reliability coefficients were 0.824, 0.818, 0.943, and 0.929; the retest reliability coefficients were 0.695, 0.667, 0.725, and 0.572, respectively.Conclusions:The Chinese version of IIQ is reliable and valid and can be used to assess illness identity in patients with chronic diseases.

Objective To investigate and validate the expression profiles of Ppp3cb and Ppm1g through differential proteomic analysis of hippocampal tissue in NHE1 gene knockout mice with proteomic analysis.Method ① Six 2-week-old NHE1 knockout mice were selected as the model group,and 6 wild-type mice of the same age served as the control group,and their genotypes were detected by agar-gel electrophoresis.Open field test and forced swimming test were used to evaluate the behaviors of mice in the model group and control group,and epileptic seizure was graded according to Racine scoring.② Tandem mass spectrometry was employed to screen the differential proteins in the hippocampus tissues from the model group and the control group.Then the obtained differential proteins were annotated and enriched in the Gene Ontology(GO)database.Search tool for the retrieval of interesting genes(STRING)database was used to analyze protein-protein interaction(PPI)among different proteins.③ The transcriptional and translational levels of Ppp3cb and Ppm1g were detected by qPCR and Western blotting,respectively,and their expression levels in the tissues were observed with immunohistochemistry.Results ① NHE1 was not expressed in the model group.The mice of the model group had shorter total movement distance(P=0.007 3)and less crossing cells(P＜0.000 1)in open field test,and longer period of immobility in forced swimming test(P＜0.000 1)when compared with those from the control group.② When fold change ≥1.2 times and P＜0.05 were set as the significant threshold for differential expression,845 differentially expressed protein sites were detected in the hippocampus,among which 9 proteins(including Ppm1g)were up-regulated and 7 ones(including Ppp3cb)were down-regulated.Gene Ontology(GO)functional analysis showed that after NHE1 knockout,the most significant differences were observed in the concentration of molecular function(MF)related to protein serine/threonine phosphatase activity,concentration of cellular component(CC)related to the plasma membrane,and concentration of biological process(BP)related to negative regulation of biological processes and immune system processes.STRING analysis indicated that the differential proteins Ppp3cb and Slc9a1 directly acted,Ppm1g indirectly acted through Ppp3cb and Slc9a1,and Ppp3cb and Ppm1g interacted.③The transcriptional and translational levels of Ppp3cb were decreased,and its expression level was reduced in the tissues,while those of Ppm1g were increased,and its expression was elevated in the tissues(P＜0.05).Conclusion In the hippocampus of NHE1 gene knockout mice,the expression of differential protein Ppp3cb is down-regulated and that of Ppm1g is up-regulated,which provide a basis for further study on their involvement in the pathogenesis of epilepsy.

Objective To explore the potential categories and influencing factors of the fear of progression in patients with inflammatory bowel diseases(IBD).Methods IBD patients who received inpatient treatment in a tertiary hospital in Nanjing from July 2022 to July 2023 were selected as the study subjects by convenience sampling method.The General Demographic Information Questionnaire,the Chinese version of the Fear of Progression Questionnaire-Short Form(FoP-Q-SF),the Chinese version of Inflammatory Bowel Disease Self-efficacy Scale(IBD-SES),and Social Support Rating Scale(SSRS)were administered to the participants.We applied one-way ANOVA and Logistic regression analysis to identify the factors associated with the potential categories of the fear of progression.Results A total of 303 retumed questionnaires(out of the 310)were valid,resulting an effective response rate of 97.74％.According to the results of latent profile analysis,we classified the respondents into 3 categories by the fear of progression,namely"low risk fear of disease adaptation group"(n=127,41.91％),"medium risk fear of illness distress group"(n=139,45.88％),"high risk fear of dysfunction group"(n=37,12.21％).3 groups showed statistically significant differences in permanent address,self-rated financial pressure,current disease status and self-efficacy(P＜0.05).Conclusion Patients with IBD had obvious differences in characteristics on the fear of progression.Nursing personnel should formulate personalized intervention strategies based on the classification characteristics of the fear of progression of IBD patients.Moreover,nurses should focus on improving patients'self-efficacy and promoting patients to treat medical care,stress and emotion management correctly.

After undergoing the long-term lived experience of symptoms and suffering, chronic patients change the understanding of self and try to create or regain a coherent sense of self, resulting in different degrees of illness identity. This research reviewed the origin, connotation, assessment tools, and summarized the performance level, influencing factors and intervention studies of illness identity in patients with chronic disease. It would provide references for research of illness identity, and to provide new ideas for promoting patients with chronic diseases to cope with and manage diseases.

Objective:To investigate the clinical, genetic, and pathological features of nemaline myopathy type 8 (NEM8) caused by KLHL40 gene variation. Methods:The clinical data, gene sequencing results, and musculoskeletal pathophysiology of two cases (a pair of twins) with NEM8 admitted to our hospital in July 2022 were collected. CNKI, VIP, Wanfang, Yiigle, PubMed, Embase, and Web of Science Database were searched with the English and Chinese terms "nemaline myopathy type 8", "nemaline body myopathy type 8", and " KLHL40" from January 2007 to February 2023. The clinical, genetic, and musculoskeletal characteristics of the NEM8 cases were summarized using the descriptive statistical analysis method. Results:(1) Case report: The mother (G2P2) of the twins (Ⅳ-2 and Ⅳ-3) was conceived by IVF-embryo transfer and delivered at 37 +1 gestational weeks. The two cases were dizygotic twins whose maternal grandmother had lip and palate cleft. The first baby (Ⅳ-1) of the woman exhibited absent left pinna, contracture at the end of both fingers, talipes equinovarus in both feet and died of respiratory failure two hours after birth. Fetal edema and fetal movement delay in the twins and varus right foot in one twin were found during pregnancy. Both cases developed intrapartum asphyxia with the clinical manifestations of generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fractures. The families withdrew the treatment and the twins died after maintaining life with ventilators for 53 days after birth. Whole exome sequencing of the pedigree found c.1779G>T (p.W593C) homozygous variants of the KLHL40 gene in the twins and c.1779G>T (p.W593C) heterozygous variants of the KLHL40 gene in the parents, both were de novo. Musculoskeletal pathophysiology indicated that muscle fibers are thin and round with a fetal shape and absent rod. (2) Literature review: Among the 29 cases of NEM8, including two current cases and 27 cases retrieved from 15 papers, eight cases terminated the pregnancies, and 21 were live births; seven cases (24.1%) with positive family history; 19 cases (65.5%) were found with abnormalities during pregnancy, including abnormal fetal movements, polyhydramnios, joint contracture, and fetal edema. Of the 21 live births, 20 cases had intrapartum asphyxia, 21 had postnatal respiratory failure, 20 had generalized muscle weakness, and 19 had dysphagia. Among the 29 cases, 17 cases (58.6%) were homozygous variants of the KLHL40 gene, and 12 cases (41.4%) were compound heterozygous variants. The detection rate of c.1516A>C(p.Thr506Pro) was the highest [72.4% (21/29)], followed by c.602G>A(p.Trp201*) [17.2% (5/29)]. Out of the 15 cases who underwent musculoskeletal pathological examination, all had abnormal muscle fiber size and morphology; 10 cases had rods. Conclusions:NEM8 should be considered for those with abnormal fetal movements, polyhydramnios, joint malformation, fetal edema during the fetal period and failure to establish respiration at birth as well as postnatal generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fracture. Moreover, genetic detection should be performed as soon as possible. NEM8 can be diagnosed in ones with KLHL40 gene homozygous or compound heterozygous variants and musculoskeletal pathological results of abnormal size and shape of muscle fibers, regardless of the presence of rods.

Background Operation and maintenance work in the power grid industry often involving climbing, manual handling, and poor postures causing serious problems like work-related musculoskeletal disorders (WMSDs). The influencing factors of WMSDs are not very clear, but the problem has been widely concerned in this industry. Objective To understand the prevalence and influencing factors of WMSDs among climbing task-involved workers in power supply enterprises. Methods Using a cross-sectional design, a total of 702 workers involving climbing task from 10 power supply enterprises in Jilin Province, Tianjin Municipality, and Shandong province were selected as study subjects using cluster sampling. The Musculoskeletal Disorders Questionnaire which was revised by Lei Yang was used to estimate the prevalence and identify related factors of WMSDs. \begin{document}$ {\chi ^2} $\end{document} test and multiple logistic regression were used to analyze the data. Results A total of 702 subjects were approached, 649 valid questionnaires were recovered, and the effective recovery rate was 92.45%. The prevalence of WMSDs was 81.2%, and neck (65.0%), low back (59.0%), and shoulders (54.4%) were areas of high prevalence of WMSDs. The multiple logistic regression analysis results showed that sometimes and often/very often holding awkward postures were the risk factors of neck, shoulders, low back, knees, upper back, hands/wrists, ankles/feet, elbows, and hips/thighs WMSDs; the OR (95%CI) values were 1.931 (1.260-2.959) and 3.145 (1.810-15.465), 2.700 (1.694-4.305) and 3.888 (2.224-6.798), 1.860 (1.213-2.852) and 3.150 (1.833-5.414), 2.348 (1.456-3.785) and 3.689 (2.130-6.388), 1.782 (1.128-2.815) and 3.274 (1.935-5.538), 1.710 (1.014-2.884) and 2.595 (1.455-4.630), 1.836 (1.019-3.305) and 2.860 (1.526-5.358), 2.250 (1.185-4.275) and 3.032 (1.505-6.108), 2.080 (1.048-4.128) and 3.127 (1.501-6.516), respectively. Department staff shortage was the risk factor of neck, shoulders, low back, upper back, hands/wrists, and ankles/feet WMSDs; the OR (95%CI) values were 1.791 (1.038-3.093), 2.000 (1.119-3.573), 2.506 (1.429-4.394), 2.063 (1.113-3.822), 2.256 (1.069-4.762), and 2.699 (1.103-6.601), respectively. Frequent knee bending was the risk factor of knees, upper back, and hands/wrists WMSDs; the OR (95%CI) values were 1.895 (1.327-2.704), 1.586 (1.131-2.224), and 2.026 (1.390-2.951), respectively. Often pushing/pulling heavy objects was the risk factor of shoulders, low back, and hips/thighs WMSDs; the OR (95%CI) values were 1.485 (1.066-2.192), 1.547 (1.064-2.749), and 1.822 (1.160-2.862), respectively. Long-time heavily neck tilting forward was the risk factor of elbows and hips/thighs WMSDs; the OR (95%CI) values were 1.649 (1.068-2.546) and 2.005 (1.285-3.129) respectively. Long-time ankle or foot bending was the risk factor of ankles/feet and elbows WMSDs; the OR (95%CI) values were 2.481 (1.685-3.655) and 1.655 (1.065-2.571) respectively. Cold or changes in temperature was the risk factor of neck and shoulders WMSDs; the OR (95%CI) values were 2.182 (1.072-4.443) and 2.116 (1.010-4.431) respectively. Exercise was the protective factor of neck, shoulders, low back, upper back, and ankles/feet WMSDs; the OR (95%CI) values were 0.493 (0.363-0.666), 0.625 (0.438-0.888), 0.404 (0.283-0.576), 0.570 (0.408-0.797), and 0.639 (0.436-0.937), respectively. Conclusion The prevalence of WMSDs is high among workers involving climbing task in power supply enterprises, and neck, low back, and shoulders are the most commonly affected body parts. The influencing factors involve awkward postures, repetitive movements, repetitive tasks, pushing/pulling heavy objects, staff shortage, poor working environment, and exercise.

Background Power grid is a basic industry of national economy. The occupational health problems among operation and maintenance workers in this industry have become increasingly prominent in recent years, and they should receive enough attention. Objective To estimate the prevalence of work-related musculoskeletal disorders (WMSDs) of neck and shoulder among operation and maintenance workers of power supply enterprises, and analyze related influencing factors. Methods From March to June 2021, a total of 1433 operation and maintenance worker from 10 power supply enterprises in three provinces of North China were selected as research subjects using cluster sampling method. A revised Musculoskeletal Disorders Questionnaire was used to investigate the prevalence and ergonomic factors of neck and shoulder pain in the past year. χ² test and logistic regression model were used to explore influencing factors of neck and shoulder pain among operation and maintenance workers. Results A total of 1343 valid questionnaires were recovered and the effective recovery rate was 93.72%. The neck pain prevalence was 66.0% (886 cases) and the shoulder pain prevalence was 54.1% (727 cases). The multiple logistic regression analysis results showed that often/very often long-time sitting (OR=1.864, 95%CI: 1.236-2.811; OR=1.659, 95%CI: 1.091-2.524), sometimes holding awkward postures (OR=1.695, 95%CI: 1.294-2.219; OR=1.596, 95%CI: 1.218-2.092), often/very often holding awkward postures (OR=2.416, 95%CI: 1.618-3.607; OR=2.058, 95%CI: 1.405-3.015), long-time slight neck tilting forward (OR=1.327, 95%CI: 1.023-1.722; OR=1.571, 95%CI: 1.221-2.022), long-time elbows bending (OR=1.327, 95%CI: 1.023-1.722; OR=1.506, 95%CI: 1.112-2.040) and department or team staff shortages (OR=1.578, 95%CI: 1.153-2.161; OR=1.831, 95%CI: 1.320-2.539) were associated with higher neck and shoulder pain prevalence rates. While exercise (OR=0.630, 95%CI: 0.492-0.809; OR=0.707, 95%CI: 0.557-0.899) was associated with lower neck and shoulder pain prevalence rates. Doing same work every day (OR=1.704, 95%CI: 1.305-2.225) was associated with a higher neck pain prevalence rate. Awkward postures with ineffectual force (OR=1.808, 95%CI: 1.226-2.665) and often keeping arms above shoulders (OR=1.424, 95%CI: 1.017-1.992) were associated with a higher shoulder pain prevalence rate. Conclusion The prevalence rates of neck and shoulder pian are high among operation and maintenance workers of power supply enterprises in selected three provinces of North China, and the main associated factors include individual factors, awkward work postures, and labor organization.

Background Long working hours is harmful to the physical and mental health of occupational groups, and should receive active attention. Objective To evaluate the current status of long working hours among operation and maintenance workers of power supply enterprises, and explore its effects on work-related musculoskeletal disorders (WMSDs) of the population. Methods From March to June 2021, a cross-sectional survey was conducted among 1433 operation and maintenance workers from 10 power supply enterprises in Jilin Province, Shandong Province, and Tianjin Municipality using cluster sampling. A total of 1433 copies of revised Mus-culoskeletal Disorders Questionnaire were distributed, 1343 questionnaires were recovered, and the recovery rate was 93.72%. The questionnaire included general information, personal health behaviors, weekly working hours, work-related factors, and musculoskeletal pain or discomfort in nine body parts in the past 12 months. χ² test and multiple logistic regression models were used to investigate the relationships between long working hours (>40 h per week) and WMSDs. Results The average age of the workers was (39.42±9.89) years, and the average work experience was 11.00 (5.00, 21.00) years. There were 1158 males (86.22%) and 185 females (13.78%). The average weekly working hours of the workers were (47.98±11.35) h, and the proportion of long working hours (>40 h per week) was 61.06% (820/1343). The proportions of long working hours were higher among the workers with characteristics of male, power distribution, shift work, often/very often long-time standing, often/very often holding awkward postures, often handling heavy objects, limited space to operate, long-time neck tilting backward, keeping arms above shoulders, frequent elbow bending, repeating knee movement every minute, and repeating lower limb or foot movement every minute (all P<0.05). The prevalence rate of WMSDs was 81.53% (1095/1343) among the workers. The results of multiple logistic regression showed that after adjusting education, smoking, exercise, awkward postures, often handling heavy objects, limited space to operate, long-time heavy trunk bending, long-time neck tilting backward, and keeping arms above shoulders, compared with working ≤40 h per week, the risk of WMSDs among workers working >49 h per week was higher (OR=1.406, 95%CI: 1.011-1.955). Conclusion Long working hours is prominent among operation and maintenance workers of power supply enterprises, and increases the risk of reporting WMSDs.

Background Climbing pylons during high-voltage cable maintenance is not only a labor-intensive task, but also a challenge bringing about heat stress and mental pressure from working at height, which may lead to accumulation of muscle fatigue and work-related musculoskeletal disorders. Objective To record the local muscle fatigue during a simulated climbing task by high-voltage cable electricians based on surface electromyography (sEMG) signals, explore the characteristic changes in sEMG signals and their relationship with subjective fatigue evaluation of the task, and provide data support for developing task specific objective assessment tools for local muscle fatigue and prevention of work-related musculoskeletal disorders. Methods Ten male college students were recruited to conduct a test of a simulated pylon climbing task. The climbing distance was 60 m, and a task segment was set for every 20 m (about 100 s), recorded as T1, T2, and T3, respectively. After completing each task segment, the subjects were required to rate their subjective fatigue using the Borg's RPE Scale. Fatigue was defined by rating of perceived exertion (RPE) score ≥ 14 in this study. The sEMG signals of trapezius, erector spinae, rectus femoris, and gastrocnemius muscles were recorded wirelessly. The standardized maximal voluntary electrical activation (MVE) obtained by standardizing the root mean square (RMS) of the time domain index and the median frequency (MF) of the frequency domain index were estimated for the recorded sEMG signals, and joint amplitude and spectrum analysis (JASA) was used to evaluate local muscle fatigue of target muscles involving in the climbing task. Results The RPE scores of T1, T2, and T3 were 11.9, 15.3, and 17.4, respectively. Subjective fatigue was found in T2 and T3 but not in T1. With the extension of climbing time, the MVE values of left and right erector spinae muscles, left and right rectus femoris, and right gastrocnemius muscle increased gradually, while the MVE values of left and right trapezius muscles and left gastrocnemius muscle increased first and then decreased. The MF values of left and right rectus femoris increased at first, then remained unchanged, while the MF values of the other muscles remained basically unchanged. In T1, three muscles, including left trapezius muscle and both side of erector spinae muscles, showed fatigue; in T2, five muscles, including both sides of erector spina muscles, right trapezius muscle, and both sides of gastrocnemius muscle appeared fatigue; in T3 , except for left rectus femoris, the other seven muscles were fatigue. Conclusion The characteristic changes of electromyography signals in the simulated climbing task are not completely consistent with the typical amplitude increase and left shift of the frequency spectrum of sEMG signals in static tasks, indicating that the application of time-domain and frequency-domain analysis methods in the evaluation of muscle fatigue in climbing tasks needs further discussion. Trapezius muscles and erector spinae muscles are the first to show fatigue in the simulation, and may be the sensitive muscle groups of muscle fatigue associated with climbing movement. Compared with subjective evaluation, surface electromyography is more sensitive in the assessment of body fatigue. Fatigue is reported about 100 s of climbing (the climbing length is about 20 m).