Objectives:To explore the risk factors of postoperative delirium in elderly patients after cervical spine operation.Methods:The clinical data of 252 elderly patients treated with cervical spine surgery in our hospital from January 2019 to October 2022,including 148 males and 104 females,with a mean age of 68.9±6.1 years(60-91 years)old were retrospectively analyzed.The Confusion Assessment Method(CAM)was utilized to assess whether the patients exhibited delirium after surgery in a week,and they were divided into delirium group and non-delirium group.Data were collected,such as age,sex,disease type,smoking history,drinking history,comorbidities,body mass index(BMI),bone mineral density(BMD),sleep disorders,the Saint Louis University Mental Status(SLUMS)score,surgical approach,American Society of Anesthesiologists(ASA)grade,preoperative hematocrit and electrolytes concentration,preoperative and postoperative 1d hemoglobin and albumin levels,operative time,anesthesia time,blood loss,postoperative hospitalization in ICU,the occurrence of postoperative hypoxaemia and postoperative hypotension within 3 days;Narcotics-related drug use included:anticholinergics,benzodiazepines,dexmedetomidine;Before operation and at 3d after operation,visual analogue scale(VAS)was used to evaluate the pain status,and Japanese Orthopaedic Association(JOA)score and neck disability index(NDI)were adopted to assess the cervical function.The differences between the two groups were analyzed with independent sample t-test or x2 test,and indexes with intergroup difference were analyzed with the binary logistic regression method to determine the risk factors for delirum after operation.Results:There were 31 patients with postoperative delirium and 221 patients without delirium.Univariate analysis showed that age,stroke history,Parkinson's disease,pulmonary disease,sleep disorder,SLUMS score,preoperative albumin level,operative time,anesthesia time,blood loss,postoperative albumin level,postoperative hospitalization in ICU and postoperative hypoxemia were with statistically significant differences between delirium group and non-delirium group(P＜0.05);Sex,disease type,smoking history,drinking history,hypertension,diabetes,BMI,BMD,surgical approach,ASA grade,preoperative and postoperative VAS scores,JOA scores,NDI,and hemoglobin levels,preoperative hematocrit,electrolyte concentration,and the use of anticholinergics,benzodiazepines,and dexmedetomidine were not statistically different between the two groups(P＞0.05).The multivariate logistic regression analysis showed age ≥70 years(OR=2.844,P=0.031),stroke history(OR=3.476,P=0.012),Parkinson's disease(OR=18.815,P=0.003),pulmonary disease(OR=7.213,P=0.000),sleep disorders(OR=3.010,P=0.025),SLUMS score ≤21(OR=4.529,P=0.012),and postoperative hospitalization in ICU(OR=4.131,P=0.005)were the risk factors for delirium after cervical spinal operation.Conclusions:Elderly patients who age ≥70 years,have stroke history,Parkinson's disease,pulmonary disease,sleep disorders,SLUMS score ≤21,and are hospitalized in ICU after operation are prone to delirium after operation in cervical spine.

Objective:To analyze the clinical effect of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular joint facilitation(NJF)technique in improving the enhancement of muscle tone after stroke.Methods:From October 2020 to October 22,a total of 114 patients with increased muscle tone at lower limb during the recovery period of stroke who admitted to Beijing Rehabilitation hospital were selected,and they were randomly divided into the observation group(57 cases)and the control group(57 cases)according to the random number table method.The control group received routine rehabilitation treatment.The observation group added low-frequency rTMS and NJF training on the basis of the routine rehabilitation treatment.The differences of clinical efficacy and various indicators of muscle tone of lower limb before and after treatment between two groups were compared,which included modified Ashwonh score(MAS)scale,functional ambulation category(FAC)scale of the motor of lower limb,Fugl-Meyer motor function scale-Lower limbs(FMA-L),clinical spasmodic index(CSI),modified Barthel index(MBI)of activity ability of daily life,integrated electromyogram(IEMG)and root mean square(RMS)of tibialis anterior muscle of lower limb in electromyogram.Results:After intervention,29 cases appeared significant effect,and 23 cases appeared valid result,and 5 cases appeared invalid result in the observation group,and 20 cases appeared significant effect,and 20 cases appeared valid result,and 17 cases appeared invalid result in the control group.The total effective rate of the observation group was 91.23%,which was significantly higher than 70.18%of the control group,and the difference was statistically significant(x2=8.111,P<0.05).Before intervention,there was no statistically significant difference in each indicator between the two groups(P>0.05).The MAS score,CSI score,IEMG and RMS of two groups after intervention were significantly lower than those before intervention,while the FAC score,FMA-L score and MBI score were significantly higher than those before intervention,and the differences were significant(t=3.377,4.398,5.554,P<0.05),respectively.At the same time,the MAS score,CSI score,IEMG and RMS of the observation group were significantly higher than those of the control group,and the differences were statistically significant(t=11.160,9.625,16.993,8.095,P<0.05),respectively.Conclusion:The combined application of low-frequency rTMS and NJF training can significantly improve the enhancement of muscle tone after stroke,and effectively reduce the muscle tone of lower limb,and improve the motor function of lower limb and the degree of spasticity,and improve the activity ability of daily life.

Objective To establish the method for simultaneous determination of six index components in the water extract of Weile Prescription;To optimize the water extraction process.Methods UPLC-MS/MS was used with Waters CORTECS C18 column(2.1 mm×100 mm,1.6 μm)as the chromatographic conditions;the mobile phase was 0.1%formic acid water-acetonitrile with gradient elution;the flow rate was 0.25 mL/min;the column temperature was 40℃;the sample volume was 2 μL.Electrospray negative ion source,positive and negative ion switching multi-reaction monitoring(MRM)mode were detected.Taking the content of six index components(gallic acid,vitexin,paeoniflorin,naringin,hesperidin and glycyrrhizic acid)and extraction rate as evaluation indexes,the weight coefficient of each index was determined by G1-entropy weight method,and the optimum parameters of extraction process were determined by orthogonal experiment design with the amount of water,extraction time and extraction times as investigation factors.Results There was a good linear relationship of the six components in the water extract of Weile Prescription in the concentration range(r>0.999),and the average recovery rate was 96.83%-102.56%,RSD<4.0%.The best technological parameters were as follows:Chinese decoction pieces were soaked in 12 times of water for 2 h,and extracted twice,each time for 1.5 h.Conclusion The UPLC-MS/MS method established in the study for simultaneous determination of six components in Weile Prescription is rapid,simple and sensitive,and the optimized extraction process is stable and feasible,which provides experimental basis for the development and research of the preparation.

Objective We propose a low-dose CT reconstruction method using partial differential equation (PDE) denoising under high-dimensional constraints. Methods The projection data were mapped into a high-dimensional space to construct a high-dimensional representation of the data, which were updated by moving the points in the high-dimensional space. The data were denoised using partial differential equations and the CT image was reconstructed using the FBP algorithm. Results Compared with those by FBP, PWLS-QM and TGV-WLS methods, the relative root mean square error of the Shepp-Logan image reconstructed by the proposed method were reduced by 68.87％, 50.15％ and 27.36％, the structural similarity values were increased by 23.50％, 8.83％ and 1.62％, and the feature similarity values were increased by 17.30％, 2.71％ and 2.82％, respectively. For clinical image reconstruction, the proposed method, as compared with FBP, PWLS-QM and TGV-WLS methods, resulted in reduction of the relative root mean square error by 42.09％, 31.04％and 21.93％, increased the structural similarity values by 18.33％, 13.45％ and 4.63％, and increased the feature similarity values by 3.13％, 1.46％ and 1.10％, respectively. Conclusion The new method can effectively reduce the streak artifacts and noises while maintaining the spatial resolution in reconstructed low-dose CT images.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective We propose a low-dose CT reconstruction method using partial differential equation (PDE) denoising under high-dimensional constraints. Methods The projection data were mapped into a high-dimensional space to construct a high-dimensional representation of the data, which were updated by moving the points in the high-dimensional space. The data were denoised using partial differential equations and the CT image was reconstructed using the FBP algorithm. Results Compared with those by FBP, PWLS-QM and TGV-WLS methods, the relative root mean square error of the Shepp-Logan image reconstructed by the proposed method were reduced by 68.87％, 50.15％ and 27.36％, the structural similarity values were increased by 23.50％, 8.83％ and 1.62％, and the feature similarity values were increased by 17.30％, 2.71％ and 2.82％, respectively. For clinical image reconstruction, the proposed method, as compared with FBP, PWLS-QM and TGV-WLS methods, resulted in reduction of the relative root mean square error by 42.09％, 31.04％and 21.93％, increased the structural similarity values by 18.33％, 13.45％ and 4.63％, and increased the feature similarity values by 3.13％, 1.46％ and 1.10％, respectively. Conclusion The new method can effectively reduce the streak artifacts and noises while maintaining the spatial resolution in reconstructed low-dose CT images.

Objective To establish the method for the simultaneous determination of hypoxanthine, inosine, guanosine and adenosine in Dilong formula granules by HPLC and compare the fingerprints of Dilong formula granules from different manufacturers by HPLC chromatogram. Methods The contents of hypoxanthine, inosine, guanosine and adenosine were determined by Thermo Acclaim^TM120C₁₈ column (4.6 mm×250 mm 5 μm). The mobile phase was acetonitrile-water. Gradient elution with flow rate of 0.6 ml/min was used. Column temperature was 25 ℃. Detection wavelength was 254 nm. 10 batches of samples were tested. The HPLC chromatogram were compared and analyzed by using the similarity Evaluation system of chromatographic fingerprint of traditional Chinese Medicine (version 2012.130723). Results The linear ranges for the detection of hypoxanthine, inosine, guanosine and adenosine showed good linear relationships within their own ranges (r≥0.999 9). The average recoveries were 99.20%~102.98% with RSD of 0.26 %~0.71%. The contents of 4 components in 10 batches of samples were 0.740 0~4.457 4 mg/g, 2.132 3~7.805 0 mg/g, 0.325 4~1.596 1 mg/g, 0.537 2~2.222 9 mg/g respectively. The similarity between HPLC chromatogram and control fingerprints of Dilong formula granules from different manufacturers was greater than 0.91. Conclusion The method could be used to determine the contents of hypoxanthine, inosine, guanosine and adenosine in Dilong formula granule. HPLC fingerprints could be used to evaluation the quality in Dilong formula granule. The similarity of HPLC fingerprints from different manufacturer production of Dilong formula granule is high, but 4 contents in composition are difference.

Objective To establish the Good Agricultural Practice（GAP）for standard operation procedure of Shanghai Pheretima. Methods According to the comprehensive technical requirements of GAP standardized production of Chinese herbal medicine, the key technologies of standardized cultivation and processing were studied in Sangxin Town, Chongming District, Shanghai. Results The production area environment, variety characteristics, breeding technology, pest control, harvesting and processing, packaging, storage and transportation, quality monitoring and other technical links of Shanghai Pheretima were clearly defined and standardized. Conclusion This study provides practical basis for the standardization and modernization quality management of Shanghai Pheretima.

Objective To investigate the efficacy of aripiprazole addition therapy on adiponectin and leptin in schizophrenia patients with olanzapine-induced weight gain. Methods Schizophrenia patients with clinically significant weight gain induced by olanzapine were randomly divided into two groups:treated with olanzapine+aripiprazole (5 mg/d, n=48) or olanzapine+placebo (n=46). The level of FBS, TG, TC, adiponectin, leptin, the body index (BMI) and the insu?lin resistance index (HOMA-IR) were measured before and 4, 8 and 12 weeks after treatment. Results Adiponectin in?creased and leptin as well as HOMA-IR decreased in olanzapine+aripiprazole group after 4, 8 and 12 weeks treatment (P<0.05). However, FBS, TG and TC decreased and BMI increased only after 8 and 12 weeks treatment(P<0.05). In olanzapine+placebo group, the dadiponectin decreased and leptin, HOMA-IR as well as BMI increased after 8 and 12 weeks treatment(P<0.05). In olanzapine + aripiprazole group the adiponectin, leptin and HOMA-IR of 4, 8 and 12 weeks and BMI of 8 and 12 weeks were different from olanzapine + placebo group(P<0.05). Conclusions In schizo?phrenia patients with olanzapine-induced weight gain, aripiprazole addition therapy can ameliorate the HOMA-IR and BMI probably through the regulation of adiponectin and leptin.

Objective To study the prevalence and associated factors of loneliness in individuals with speech disability.Methods Using multi-stage stratified random cluster sampling method,170 community-residing ver-bally disabled persons were selected and administered with a general information questionnaire,one single -item loneliness self-rating question and social support scale.A total of 204 study questionnaires were distributed to the subjects;170 subjects(mean age:43.1±13.7 years)completed the survey.Results As high as 46.47% (79/170)of these verbally disabled individuals reported to feel lonely often.Females (OR=2.45),unemployment (OR=2.95), first and second degrees of disability (OR=4.35),co-existence of chronic illnesses (OR=6.50)and low utiliza-tion of social support (OR=2.58)were significantly associated with the increased risk of loneliness in persons with speech disability (P =0.002~0.046).Conclusion Loneliness is highly prevalent in individuals with speech disabili-ty.Verbally disabled persons,who are female,unemployed,severely disabled,and chronically ill and have a low use of social support,are the target population of mental health services.