Objective:To investigate the effects of moxibustion,filiform needle acupuncture,and electroacupuncture on synovial hypoxia and expression of synovial fibrosis markers[transforming growth factor(TGF)-β and collagen alpha-1(Ⅰ)chain(COL1A1)]in knee osteoarthritis(KOA)rats.Methods:Fifty Sprague-Dawley rats were randomly divided into a normal group,a model group,a moxibustion group,an acupuncture group,and an electroacupuncture group,with 10 rats in each group.Except for the normal group,rats in the other four groups were injected with sodium iodoacetate into the right knee joint cavity to establish KOA models.The right Futu(ST32)and Zusanli(ST36)were selected in the moxibustion,acupuncture,and electroacupuncture groups to perform the mild moxibustion with moxa sticks,filiform needle acupuncture,or electroacupuncture,respectively.Each intervention lasted 15 min,once every other day,and continued for 4 weeks,with a total of 14 interventions.The Lequesne score was used to evaluate the degree of knee dysfunction before and after intervention,and the rat's right knee joint diameter was measured to evaluate the degree of knee swelling.Morphological changes of the right knee joint synovial tissue were observed using hematoxylin-eosin staining.Hypoxia probe immunofluorescence staining was used to observe the degree of synovial hypoxia in rats.Western blotting was used to detect the protein expression levels of hypoxia-inducible factor(HIF)-1α,TGF-β,and COL1A1 in the synovial tissue of the right knee joints.Results:Before intervention,the Lequesne score and the right knee joint diameter in the other four groups increased significantly compared to the normal group(P<0.01).After intervention,the Lequesne score and the right knee joint diameter increased significantly in the model group compared to the normal group(P<0.01)together with worsened cartilage deformation and osteophytes,inflammatory cell infiltration and fibrosis in synovial tissue,and hypoxia degree,and the expression levels of HIF-1α,TGF-β,and COL1A1 proteins in the knee joint synovial tissue of rats increased(P<0.01).The Lequesne score and the right knee joint diameter decreased significantly(P<0.01 or P<0.05),the cartilage morphology was normal without obvious osteophytes,and the hypoxia degree reduced in the three intervention groups compared to the model group.Among them,the moxibustion group had the most notable improvement in hypoxia,synovial tissue fibrosis,angiogenesis,and inflammatory cell infiltration.The expression levels of HIF-1α,TGF-β,and COL1A1 proteins decreased in the moxibustion and electroacupuncture groups(P<0.01),and the expression levels of HIF-1α and TGF-β proteins were decreased in the acupuncture group(P<0.01).Conclusion:Moxibustion,filiform needle acupuncture,and electroacupuncture improve knee joint function and reduce knee joint swelling in KOA rats.The mechanism may be to improve synovial fibrosis of the knee joint by regulating HIF-1α;moxibustion has the best effect on improving hypoxia among the three interventions,but the effect of filiform needle acupuncture on COL1A1 is not significant.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Objective:To investigate the effects of moxibustion,filiform needle acupuncture,and electroacupuncture on synovial hypoxia and expression of synovial fibrosis markers[transforming growth factor(TGF)-β and collagen alpha-1(Ⅰ)chain(COL1A1)]in knee osteoarthritis(KOA)rats.Methods:Fifty Sprague-Dawley rats were randomly divided into a normal group,a model group,a moxibustion group,an acupuncture group,and an electroacupuncture group,with 10 rats in each group.Except for the normal group,rats in the other four groups were injected with sodium iodoacetate into the right knee joint cavity to establish KOA models.The right Futu(ST32)and Zusanli(ST36)were selected in the moxibustion,acupuncture,and electroacupuncture groups to perform the mild moxibustion with moxa sticks,filiform needle acupuncture,or electroacupuncture,respectively.Each intervention lasted 15 min,once every other day,and continued for 4 weeks,with a total of 14 interventions.The Lequesne score was used to evaluate the degree of knee dysfunction before and after intervention,and the rat's right knee joint diameter was measured to evaluate the degree of knee swelling.Morphological changes of the right knee joint synovial tissue were observed using hematoxylin-eosin staining.Hypoxia probe immunofluorescence staining was used to observe the degree of synovial hypoxia in rats.Western blotting was used to detect the protein expression levels of hypoxia-inducible factor(HIF)-1α,TGF-β,and COL1A1 in the synovial tissue of the right knee joints.Results:Before intervention,the Lequesne score and the right knee joint diameter in the other four groups increased significantly compared to the normal group(P<0.01).After intervention,the Lequesne score and the right knee joint diameter increased significantly in the model group compared to the normal group(P<0.01)together with worsened cartilage deformation and osteophytes,inflammatory cell infiltration and fibrosis in synovial tissue,and hypoxia degree,and the expression levels of HIF-1α,TGF-β,and COL1A1 proteins in the knee joint synovial tissue of rats increased(P<0.01).The Lequesne score and the right knee joint diameter decreased significantly(P<0.01 or P<0.05),the cartilage morphology was normal without obvious osteophytes,and the hypoxia degree reduced in the three intervention groups compared to the model group.Among them,the moxibustion group had the most notable improvement in hypoxia,synovial tissue fibrosis,angiogenesis,and inflammatory cell infiltration.The expression levels of HIF-1α,TGF-β,and COL1A1 proteins decreased in the moxibustion and electroacupuncture groups(P<0.01),and the expression levels of HIF-1α and TGF-β proteins were decreased in the acupuncture group(P<0.01).Conclusion:Moxibustion,filiform needle acupuncture,and electroacupuncture improve knee joint function and reduce knee joint swelling in KOA rats.The mechanism may be to improve synovial fibrosis of the knee joint by regulating HIF-1α;moxibustion has the best effect on improving hypoxia among the three interventions,but the effect of filiform needle acupuncture on COL1A1 is not significant.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Rehabilitation medicine is one of the most important specialties in community health institutions. This article introduces the 12 year′s development of rehabilitation medicine in Fenglin Community Health Service Center, focusing on the talent allocation, service capabilities, resource expansion, basic facilities, personnel recruiting, department operating, service scope, and its achievements and influence, to provide reference for planning and construction of featured specialty in community health service centers.

Community health institutions have entered a new development stage of featured specialty construction. After 12 years of development, rehabilitation medicine now is the featured specialty of Fenglin Community Health Service Center. This article presents the train of thought and key points of specialty construction in primary care institutions based on the Fenglin′s experience. The positioning of featured specialty should be based on the community. The construction process should include 7 elements, namely, the standard operation procedure(SOP)of service system construction, the detailed publicity and implementation of the collaboration of specialists, prevention and control knowledge promotion for general practitioners, prevention and control knowledge education for community residents, service list, clinical efficacy evaluation, and clinical database. In the later iterations, the head of the department should always focus on the service system construction SOP and clinical database construction, and the rest parts can be assigned to the relevant team members.

OBJECTIVE：To study the spectrum-effect relationship of HPLC finger print of different polar parts of Ampelopsis grossedentata with its in vivo anti-inflammatory effect. METHODS ：A. grossedentata was reflux extracted with 70％ ethanol，then extracted with petroleum ether ，chloroform，ethyl acetate and water saturated n-butanol；or it was directly decocted with water and then concentrated to obtain different polar parts. The xylene-induced mice ear swelling model was established ；using dexamethasone as positive control ，anti-inflammatory activity of different polar parts of A. grossedentata was investigated. Fingerprints of different polar parts of A. grossedentata were established by HPLC. The determination was performed on Poroshell 120 EC-C18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid solution （gradient elution ）at the flow rate of 1 mL/min. The column temperature was 25 ℃. The detection wavelength was set at 365 nm，and sample size was 5 μL. The grey ralational analysis method was used to analyze the spectrum-effect relationship of HPLC fingerprint common peaks of different polar parts of A. grossedentata with its anti-inflammatory effect. The correlation coefficient and correlation degree were calculated and ranked. RESULTS：Anti-inflammatory experiment showed that the anti-inflammatory effects of 70％ ethanol extraction part ，ethyl acetate extraction part and water extraction part were the most significant （inhibitory rates of ear swelling were 54.07％，30.54％， 30.45％）. Five common peaks were determined in HPLC fingerprints of different polar parts from A. grossedentata . The spectrum-effect analysis results showed that the correlation of5 common peaks were higher than 0.6；among them ，peak 3 and peak 2 （dihydromyricetin） had the strongest anti- inflammatory effect ，and their correlation degrees were both mail：123745789@qq.com greater than 0.8. CONCLUSIONS ： The anti-inflammatory effect of A. grossedentata on xylene-induced ear swelling in mice is the result of multi-comp onent synergy ； unknown substance of peak 3 and dihydromyricetin may be the main active components of A. grossedentata .

OBJECTIVE：To establish a method for simultaneous determination of gallic acid ，protocatechuic acid ，mangiferin， homomangiferin，hyperoside and isoquercetin in Mangguo zhike tablets. METHODS ：HPLC was adopted. The determination was performed on Phenomenex Gemini C 18 column with mobile phase consisted of 0.1％ phosphoric acid water solution-acetonitrile （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelength was set at 258 nm. The column temperature was set at 30 ℃，and sample size was 5 μL. Gallic acid was used as the internal substance，and the correction factors of gallic acid ， protocatechuic acid ，mangiferin，homomangiferin，hyperoside and isoquercetin were calculated ；the results of quantitative analysis of multi-components by single marker method （QAMS） were compared with those of external standard method （ESM）. RESULTS：The linear range of gallic acid ，protocatechuic acid ，mangiferin，homomangiferin，hyperoside and isoquercetin were 45.75-183 0 μg/mL（r＝0.999 9），2.525-101.0 μg/mL（r＝0.999 9），65.33-261 3 μg/mL（r＝0.999 6），9.058-362.3 μg/mL（r＝ 0.999 9），3.885-155.4 μg/mL（r＝0.999 9），1.870-74.8 μg/mL（r＝0.999 9），respectively. The limits of quantification were 0.571， 0.643，1.053，0.854，0.830，1.500 μg/mL，respectively. The limits of detection were 0.171，0.193，0.316，0.256，0.249，0.450 μg/mL， respectively. RSDs of precision ，stability and reproducibility tests were all lower than 3％ . The average recoveries were 98.8％-101.9％（RSD＝1.3％ ，n＝6），94.3％-101.5％（RSD＝3.3％，n＝6），97.9％-100.5％（RSD＝0.9％，n＝6），98.2％- 101.6％ （RSD＝1.2％，n＝6），102.3％-106.1％（RSD＝1.3％，n＝6）， 96.6％ -99.3％（RSD＝1.0％ ，n＝6），respectively. RCFs of 73） protocate-chuic acid ， mangiferin， homomangiferin，hyperoside and isoquercetin were 0.568 3，0.500 3，0.687 6， 0.939 1 and 0.826 3，using gallic acid as internal substance . The content ranges of protocatechuic acid and other 4 com- ponents measured by QAMS were 0.197-0.440，3.262-11.250， 0.201-1.196，0.168-0.381，0.115-0.293 mg/tablet，respectively. The content ranges measured by ESM were 0.198-0.441，3.239-11.570，0.206-1.194，0.171-0.380，0.119-0.298 mg/tablet， respectively. By comparing the content determination results by QAMS and ESM ，the relative errors were －3.80％-0.74％，and there was no statistical significance （P＞0.05）. CONCLUSIONS ：The established QAMS method is accurate ，reliable and repeatable，and can be used for content determination of 6 medicinal components in Mangguo zhike tablets.

To establish a high performance liquid chromatography(HPLC)method to determine the content of bacteriostats in the ocular extractives eye drops, Diamonsil C18(4. 6 mm×250 mm, 5 μm)column was used, with gradient elusion by 1% triethylamine solution(pH 3. 0)(mobile phase A)and methanol(mobile phase B). The detection wavelength was 256 nm; the column temperature was 40 °C; and the flow rate was 1. 0 mL/min. Under these conditions, the three bacteriostats of methylparaben, ethylparoben and chlorhexidine acetate showed good resolution. The bacteriostats exhibited good linear relationship between the peak area and the concentration in the concentration range of 0. 1- 80 μg/mL(r> 0. 999 1). The recoveries were from 97. 2% to 104. 1%, and the RSD was 0. 8% to 1. 2%. The content of bacteriostats in all the five batches of ocular extractives eye drops was less than 10% of the prescription amount. It was found that the activated carbon used in the production process had strong adsorption effect on the bacteriostat, and that the lower the temperature and the higher the concentration of activated carbon, the stronger the adsorption of bacteriostatic agent. The adsorption capacity of activated carbon for different bacteriostats is: chlorhexidine acetate > ethylparoben > methylparaben. The results showed that the established HPLC method was easy to operate with high sensitivity and good repeatability. It can be used to determine the content of bacteriostat in ocular extractives eye drops quickly and accurately. In addition, this study reveals for the first time the effect of impurity removal process on bacteriostat in the production of ocular extractives eye drops. It is not suitable to use activated carbon to remove impurities before adding parabens and chlorhexidine acetate bacteriostats. The current work provides a new guiding basis for the monitoring and improvement of the quality of ocular extractives eye drops.

Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.