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 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 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 explore the application value of the pulse index continuous cardiac output monitoring technology (PICCO) in treating severe craniocerebral injury complicating neurogenic pulmonary edema(NPE).Methods Fifty-two cases of severe craniocerebral injury complicating NPE in the intensive care medicine department of this hospital were divided into the observation group and control group,26 cases in each group.The control group adopted the routine neurological treatment measures and guided the fluid infusion by monitoring the central venous pressure(CVP),while on the basis of the control group,the treatment group monitored the hemodynamics by PICCO and guided the fluid management according to the cardiac index(CI),extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),global end diastolic volume index(GEDVI) and intrathoracic blood volume index(ITBVI).The clinical curative effects,hemodynamic indexes,intracranial pressure(ICP),average daily infusion volume,mechanical ventilation time,hospital stay and GOS prognosis evaluation were compared between the two groups.Results The improvement of the heart rate(HR),mean arterial pressure (MAP),oxygenation index(PaO2/FiO2),ICP and other indicators in the observation group was more obvious than that in the control group(P＜0.05);the CVP rise in the control group was more obvious(P＜0.05);CI,EVLWI,PVPI,GEDVI and ITBVI in the observation group were improved and stabilized;the daily average infusion amount,mechanical ventilation time and hospital stay in the observation group were less than those in the control group(P＜0.05);but the good prognosis rate and mortality rate had no significant difference between the two groups(P＞0.05).Conclusion PICCO can better conduct the liquid management,improves the clinical symptoms,shortens the mechanical ventilation time and hospitalization stay,but the results show no significant improvement in prognosis and mortality.

Objective To observe the effects of Yukouning on immunologic function in recurrent aphthous ulcer (RAU) patients with brimming heat of heart and spleen (BHHS type).Methods The study was composed of 30 patients with RAU (BHHS type) and 30 healthy individuals.All patients with RAU (BHHS type) were divided into levomisole group and Yukouning group (n =15).Patients of levomisole group were give 50 mg of levomisole,bid,lasted two days.Patients of Yukouning group were give Yukouning decoction.The changes of the class of T-cells and the levels of immunoglobulins (IgA,IgG,IgM) and complement (C3,C4) in different groups were tested by flow cytometry (FCM) and single immunodiffusion method.Results The levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients increased significantly as compared with those in healthy group (P ＜ 0.05).The level of CD4+ and the ratio of CD4+/CD8+ decreased significantly as compared with those in healthy group (P ＜0.05).Furthermore,the levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients decreased significantly after different drug treatment,respectively (P ＜ 0.05).At the same time,the level of CD8+ and the ratio of CD4+ / CD8+ increased significantly after different drug treatment,respectively (P ＜ 0.05).But all the above-mentioned indexes had no significant differences between the two drug groups (P ＞ 0.05).After 1-year follow-up,the effective rate (both 93.3％) had no significant difference between the two groups (P ＞ 0.05).Conclusion Imbalance of immune function is correlated with RAU (BHHS type).Yukouning plays a therapeutic role by regulating cellular and humoral immunity in RAU (BHHS type) patients.

Objective To explore the effect of robot-assisted gait training on the lower limb motor function and gait ability in patients with hemiplegia after stroke. Methods From January, 2015 to October 2016, 60 patients with hemiplegia after stroke were randomly divided into control group (n=30) and experimental group (n=30). Both groups received conventional rehabilitation, while the experimental group was given robot-assisted gait training and the control group was given artificial assisted gait training, 30 minutes a day, five days a week for eight weeks. They were evaluated with Fugl-Meyer Assessment-Lower Limb (FMA-LE), muscle strength of hip flexion (L-FORCE/HIP/Flex, FHF) and knee extension (L-FORCE/KNEE/Ext, FKE), Six Minutes Walking Distance and Ten Meters Walking Time before and after training. Results There was no significant difference in general data and all indexes between two groups before training (P>0.05). The scores of all the indexes improved in the experimental group after training (t>2.274, P<0.05), and all of them were better in the experimental group than in the control group (t>2.095, P<0.05), except FKE. Conclusion Robot-assisted gait training can effectively improve the lower limb motor function and gait ability of patients with hemiplegia after stroke.

Objective UPLC-MS/MS bio-analysis method was developed for the simultaneous determination ofberberine,naringin,hesperidin,and neohesperidin in plasma of rats.Methods UPLC Acquity BEH C18 (50 rmm × 2.1 mm,1.7 μm) column was used,mobile phases were containing 0.05％ formic acid and 2 mmol/L ammonium formate in water (A)-containing 0.05％ formic acid in acetonitrile (B) as the mobile phase gradient elution;SD rats were randomly divided into oral administration berberine group,Citrus aurantium extract group,and berberine and C.aurantium extract compatibility group.Results UPLC-MS/MS method could be applied to determination of berberine,naringin,hesperidin,and neohesperidin,method validation meets the requirements of biological sample analysis.When rats were administered with berberine and C.aurantium extract compatibility,the plasma concentration of berberine was much more than single dose of berberine group and the bioavailability of berberine was increased.Meanwhile,naringin and neohesperidin can be detected in rat's plasma.Conclusion The bioavailability of flavonoids is significantly improved as well compared to the single dose of C.aurantium extract.This suggests that berberine and C.aurantium extract compatibility has significant drug-drug interaction.

Objective To investigate the relationship of single nucleotide polymorphism (4G/5G) in the promoter of plasminogen activator inhibitor-1 (PAI-1) and plasma PAI-1 level with gastrointestinal bleeding in Henoch-Sch?nlein purpura (HSP). Methods A total of 524 children with HSP in acute phase were recruited, and divided into gastrointestinal bleeding group (bleeding group, n?=?186) and non-gastrointestinal bleeding group (control group, n?=?338). The genotype frequency of 4G/5G polymorphism, the plasma PAI-1 level, and other parameters related to coagulation and ifbrinolysis were measured and compared between two groups. Results The levels of platelet count (PLT), platelet distribution width (PDW), serum D dimer (DD), serum PAI-1 were signiifcantly higher in the bleeding group than those in the control group, and the levels of mean platelet volume (MPV) and plasma ifbronectin protein of ifbrinogen (FIB) were signiifcantly lower in the bleeding group than those in the control group (P?

Aim To study the role of ubiquitin carboxyl terminal hydrolase L1 (UCH-L1)involved in the pro-tective effect of fluoxetine against monocrotaline-in-duced pulmonary arterial hypertension in rats.Meth-ods Monocrotaline (60 mg·kg -1 )was used to es-tablish pulmonary arterial hypertension in rats and low-dose (2 mg·kg -1 ·d -1 )or high-dose (10 mg·kg -1 ·d -1 )fluoxetine was applied to inhibit pulmonary ar-terial hypertension.The hemodynamics,morphology of pulmonary arterioles and lungs,UCH-L1 protein ex-pression and nuclear factor-κB (NF-κB)nuclear trans-location were observed.Results Monocrotaline not only increased pulmonary arterial pressure and promo-ted pulmonary arterial remodelling and lung inflamma-tion,but also down-regulated UCH-L1 protein expres-sion and increased NF-κB activity in lungs.Fluoxetine inhibited these changes in a dose-dependent manner. However,UCH-L1 protein expression of pulmonary ar-teries did not significantly change among different groups.Conclusion Fluoxetine inhibits monocrotal-ine-induced lung inflammation in rats,involved in NF-κB activity inhibited by up-regulated UCH-L1 protein expression.