OBJECTIVE To investigate the effects of baicalin （BC） on insulin resistance in rats with gestational diabetes mellitus （GDM） and its underlying mechanism based on the adenosine monophosphate-activated protein kinase （AMPK）/suppressor of variegation 3-9 homolog 1 （SUV39H1）/histone H3 lysine 9 trimethylation （H3K9me3） axis. METHODS A GDM rat model was established by a combination of a high-fat diet and streptozotocin injection. The successfully modeled rats were divided into the GDM group， BC low-dose group， BC high-dose group， and high-dose of BC+AMPK inhibitor （Compound C） group， with 10 rats in each group. Another 10 pregnant rats fed a normal diet served as the control group. Rats in each group were given corresponding drugs/normal saline intragastrically and/or intraperitoneally， once daily for 2 consecutive weeks. After the last administration， the levels of fasting blood glucose （FBG）， pancreatic function indexes [fasting insulin （FINS）， homeostasis model assessment of insulin resistance （HOMA-IR）， insulin sensitivity index （ISI）]， blood lipid indexes （total cholesterol， triglyceride， low-density lipoprotein cholesterol）， liver function indexes （alanine transferase， aspartate transferase， alkaline phosphatase）， inflammatory indicators （C-reactive protein， interleukin-1β， interleukin-6）， metabolic regulatory protein [complement-C1q/tumor necrosis factor-related protein 3 （CTRP3）]， insulin sensitivity related factors [glucose transporter 4 （GLUT4）， adiponectin]， and oxidative stress indicators [superoxide dismutase （SOD）， catalase （CAT）， malondialdehyde （MDA）] were measured. Pathological changes in liver tissue were observed， and the expressions of proteins related to the AMPK/SUV39H1/H3K9me3 axis in liver tissue were detected. RESULTS Compared with the GDM group， rats in the BC low- and high-dose groups showed varying degrees of improvement in pathological changes such as disordered cell arrangement， vacuolar degeneration， lipid deposition， and inflammatory cell infiltration in liver tissue. Their FBG and FINS levels， HOMA-IR， the levels of blood lipid indexes， liver function indexes， inflammatory indicators and MDA， and the expressions of SUV39H1 and H3K9me3 were significantly decreased or down-regulated， while metabolic regulatory protein， insulin sensitivity-related factors and AMPK protein phosphorylation levels were significantly increased （ P ＜0.05）. The improvement was more significant in the BC high-dose group （ P ＜0.05）. Compound C could significantly reverse the ameliorative effects of high-dose BC on the above quantitative indicators （ P ＜0.05）. CONCLUSIONS BC can significantly reduce oxidative stress and inflammatory responses， increase serum levels of CTRP3， GLUT4 and adiponectin， thereby improving insulin resistance in GDM rats. These effects may be related to the activation of AMPK and inhibition of SUV39H1-mediated H3K9me3 modification.

Objective:To explore the impact of postoperative extracorporeal membrane oxygenation (ECMO) support on neurodevelopment of neonatal patients with complex congenital heart disease (CHD) and its early neurorehabilitation intervention effect.Methods:A retrospective analysis was performed; 17 neonates who underwent complex CHD corrective surgery with ECMO support in Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University from January 1, 2019 to December 31, 2021 were chosen. Neurological injury of the neonates was observed during ECMO support period. At 12 months old, the neonates underwent head MRI; and Griffiths Developmental Scale-Chinese version (GDS-C) were performed on the neonates to evaluate the neurodevelopment. A systematic neurorehabilitation intervention program was implemented for neonates with abnormal neurodevelopment as indicated by GDS-C, and GDS-C was performed again to assess the neurodevelopmental changes of the neonates at 36 months old.Results:(1) During ECMO support period, 13 neonates (76.47%) suffered from neurological damage, including 8 with simple intracranial hemorrhage, 2 with intracranial hemorrhage combined with ischemic hypoxic changes, 1 with intracranial hemorrhage combined with white matter injury, and 2 with white matter injury. (2) At 12 months old, head MRI revealed hemorrhagic foci or softening foci in 2 neonates; GDS-C indicated 12 neonates with delayed neurodevelopment, 4 with borderline status, and only 1 with normal development. (3) Among the 16 neonates with abnormal neurodevelopment who received systematic neurorehabilitation, 11 achieved normal neurodevelopment, 4 remained borderline, and 1 still had delayed development at 36 months old indicated by GDS-C. Compared with those before the neurorehabilitation intervention, the neonates after neuro-rehabilitation intervention had better neurodevelopmental rating (average ranks: 9.630 and 23.380, respectively), and significantly improved neurodevelopmental quotients in the 4 major dimensions of motor, personal-social, language, and hand-eye coordination ( P<0.05). Conclusion:Neonates accepted CHD surgery face high risks of postoperative neurological complications during ECMO support period; incidence of neurodevelopmental abnormalities is high in neonates at 12 months old; by implementing a systematic neurorehabilitation intervention, the outcomes of neonates with neurodevelopmental abnormalities can be effectively improved.

Objective:To explore the impact of postoperative extracorporeal membrane oxygenation (ECMO) support on neurodevelopment of neonatal patients with complex congenital heart disease (CHD) and its early neurorehabilitation intervention effect.Methods:A retrospective analysis was performed; 17 neonates who underwent complex CHD corrective surgery with ECMO support in Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University from January 1, 2019 to December 31, 2021 were chosen. Neurological injury of the neonates was observed during ECMO support period. At 12 months old, the neonates underwent head MRI; and Griffiths Developmental Scale-Chinese version (GDS-C) were performed on the neonates to evaluate the neurodevelopment. A systematic neurorehabilitation intervention program was implemented for neonates with abnormal neurodevelopment as indicated by GDS-C, and GDS-C was performed again to assess the neurodevelopmental changes of the neonates at 36 months old.Results:(1) During ECMO support period, 13 neonates (76.47%) suffered from neurological damage, including 8 with simple intracranial hemorrhage, 2 with intracranial hemorrhage combined with ischemic hypoxic changes, 1 with intracranial hemorrhage combined with white matter injury, and 2 with white matter injury. (2) At 12 months old, head MRI revealed hemorrhagic foci or softening foci in 2 neonates; GDS-C indicated 12 neonates with delayed neurodevelopment, 4 with borderline status, and only 1 with normal development. (3) Among the 16 neonates with abnormal neurodevelopment who received systematic neurorehabilitation, 11 achieved normal neurodevelopment, 4 remained borderline, and 1 still had delayed development at 36 months old indicated by GDS-C. Compared with those before the neurorehabilitation intervention, the neonates after neuro-rehabilitation intervention had better neurodevelopmental rating (average ranks: 9.630 and 23.380, respectively), and significantly improved neurodevelopmental quotients in the 4 major dimensions of motor, personal-social, language, and hand-eye coordination ( P<0.05). Conclusion:Neonates accepted CHD surgery face high risks of postoperative neurological complications during ECMO support period; incidence of neurodevelopmental abnormalities is high in neonates at 12 months old; by implementing a systematic neurorehabilitation intervention, the outcomes of neonates with neurodevelopmental abnormalities can be effectively improved.

Objective:To determine the median effective dose (ED 50) of remimazolam for preoperative sedation in pediatric patients of different ages. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification I or Ⅱ pediatric patients, aged 1-6 yr, scheduled for elective surgery in our hospital from July to December 2023, in whom the preoperative anxiety was still not relieved after non-drug intervention (preoperative separation anxiety score [PSAS]≥3), were selected. According to the age, the children were divided into 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group. A child's PSAS score = 1 at the time of separation from parents was classified as satisfactory sedation, and a PSAS score ≥ 2 was classified as unsatisfactory sedation. The initial dose of remimazolam in each group was 0.3 mg/kg, dose ratio 1.15. If the child was satisfactorily sedated, the next patient received a lower dose of remimazolam, or conversely if the child was not satisfactorily sedated, a higher dose was given in the next patient. The test was ended when 7 alternating waveforms appeared. The Dixon-Massey method was used to calculate the ED 50 and 95% confidence interval. Results:In 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group, a total of 120 children were included in this study, with 26, 23, 21, 27 and 23 cases, respectively, and the ED 50 (95% confidence interval) of remimazolam for preoperative sedation was 0.152 (0.126-0.178), 0.159 (0.135-0.183), 0.171 (0.147-0.196), 0.150 (0.126-0.174), and 0.146 (0.121-0.170) mg/kg, respectively. There was no significant difference between the groups ( P>0.05). Conclusions:The ED 50 of remimazolam for preoperative sedation is 0.152, 0.159, 0.171, 0.150 and 0.146 mg/kg for every 1 yr in children aged 1-6 yr, and the age factor does not affect the preoperative sedative effect of remimazolam in children of this age group.

Objective:To construct a self-management intervention program for patients with adenocarcinoma chemotherapy based on chronic disease trajectory model, and to provide reference for clinical nursing intervention.Methods:From October 2021 to June 2022, a research team was established. Based on the chronic disease trajectory model and self-management theory, through preliminary quantitative research, literature review and semi-structured interview, the first draft of the intervention plan was prepared. 24 experts were selected for two rounds of Delphi expert correspondence consultation to determine the self-management intervention plan for breast cancer patients undergoing chemotherapy based on the trajectory model of chronic disease.Results:The effective questionnaire recovery rates of the two rounds of expert letter consultation were 100%, and the coefficient of expert authority degree was 0.805 and 0.863, respectively. The mean values of importance were 4.21- 4.96 and 4.46 - 5.00, the coefficients of variation were 0.00 - 0.19 and 0.00-0.17, and the Kendall concordant coefficients were 0.123 and 0.149 ( both P<0.01). Finally, the self-management intervention scheme for breast cancer chemotherapy patients based on the trajectory model of chronic disease was constructed, including 3 first-level indicators, 6 second-level indicators and 27 third-level indicators. Conclusions:The self-management intervention program for patients with adenocarcinoma chemotherapy based on chronic disease trajectory model constructed in this study can provide a certain reference for clinical nurses to carry out targeted self-management interventions.

Objective: This study explored the predictive effects of psychological stress in early and middle puberty on subsequent emotional and behavioral problems. Methods: A cohort of 911 boys and girls from primary and secondary schools in Chongqing was studied. Psychological stress was measured in early and middle adolescence, and the levels of emotional and behavioral problems were determined in one year follow up. Logistic regression analysis was used to analyze the effects of psychological stress in early and middle adolescence on subsequent emotional and behavioral problems. Results: The average psychological stress score in early and middle adolescence was (27.96±24.95), and the average scores of internalized and externalized behavioral problems and overall problems one year later were (8.21±8.46)(6.21±5.87) and (37.90±24.68) respectively. When grouped by gender, these scores, as well as the detection rate of anxiety and depression, withdrawal, physical discomfort, thinking problems, internalization problems and overall problems, were higher in girls than boys (t/Z=-6.38，-5.63，-6.06，-3.74，-6.80，-5.47， χ 2=15.88，12.01，3.92，6.64，24.67，15.88， P <0.05). Logistic regression showed that the psychological stress scale score was a risk factor for internalized and externalized behavioral problems and overall problems( P <0.05). Conclusion Psychological stress levels in early and middle puberty have a positive predictive effect on emotional and behavioral problems in the following year.

Objective: To explore whether psychological stress in early and mid puberty is predictive of adolescent healthrisk behaviors. Methods: In April 2018, a total of 1 046 primary and secondary school students from grade 5 to 8 were recruited through purposive sampling. The basic information and psychological stress of the respondents were collected by questionnaire and physical examination. In addition, self reports of health risk behaviors were collected in October 2018. Logistic multiple regression analysis was used to analyze the relationship between psychological stress and health risk behaviors of adolescents. Results: The reported health risk behaviors of the surveyed adolescents ranking from high to low were unreasonable physical activity (62.05%), food preferences (24.76%), fighting (21.03%), suicidal ideation (17.02%), ideation of running away from home (9.85%), low mood (8.80%), smoking (4.21%), drinking (3.73%), gambling (3.63%) and internet addiction (3.06%). Logistic multiple regression analysis showed that the high level of psychological stress was a risk factor for fighting ( OR =1.02, 95% CI =1.01-1.03), suicidal ideation ( OR =1.02, 95% CI =1.01-1.03), low mood ( OR =1.02, 95% CI =1.01-1.03), ideation of running away from home ( OR =1.02, 95% CI =1.01-1.03), unreasonable physical activity ( OR =1.01, 95% CI =1.00-1.02), smoking ( OR =1.02, 95% CI = 1.00-1.03), internet addiction ( OR =1.02, 95% CI =1.00-1.03), food preferences ( OR =1.01, 95% CI = 1.00-1.02) and gambling ( OR =1.02, 95% CI =1.01-1.04)( P <0.05). Conclusion Unreasonable physical activity and food preferences are most common health risk behaviors among adolescents. Psychological stress during early to middle puberty is predictive of adolescent health risk behaviors.

OBJECTIVE To provide reference for improving the professional identity of clinical pharmacists and the quality of pharmaceutical care ，and promoting the effects of clinical pharmaceutical intervention. METHODS A questionnaire survey was conducted among clinical pharmacists in secondary and tertiary hospitals in 31 provinces（autonomous regions and municipalities ） in 2019 by stratified semi-random sampling. Through descriptive analysis of survey data ，their job satisfaction status was evaluated ； χ 2 test and Logistic regression analysis were used to analyze the influential factors of job satisfaction ；the robustness test of study results by propensity score matching method and replacement regression model ，and grouping Logistic regression of samples from hospital on different levels. Targeted improvement measures were put forward according to the results of survey . RESULTS There was statistical significance in the difference of job satisfaction among pharmacists of different professional titles （P＜0.05）. Results of Logistic regression showed that whether to participate in standardized training ，whether to obtain communication and support from patients ，whether the pharmaceutical management rules and regulations were sound ，whether to set up economic compensation means such as pharmaceutical service fee ，whether to work overload ，and whether to smoothly perform pharmaceutical care duties were significant influential factors for job satisfaction of clinical pharmacists （P＜0.05）. These results showed good robustness as tested by propensity score matching method and replacement regression model. Heterogeneity analysis results showed that the job satisfaction of clinical pharmacists in tertiary hospitals was more significantly affected by economic compensation ，while clinical pharmacists in secondary hospitals were more concerned about training opportunities and workload conditions （P＜0.05）. CONCLUSIONS The job satisfaction level of Chinese clinical pharmacists remains to be improved. Accordingly ，it is compulsory to continue the promotion of standardized training courses ，consummate the pharmaceutical management system ，and fair remuneration structure in order to improve the job satisfaction of clinical pharmacists and build a high-level clinical pharmacist team.

Objective: To explore the status of depressive symptoms among adolescents in different pubertal stages in a district of Chongqing. Methods: A self designed questionnaire and Children s Depression Inventory were administered among 1 001 students in a district of Chongqing. Score and associated factors of depressive symptoms of adolescents through descriptive statistical analysis, Chi square test, analysis of variance and Logistic regression analysis. Results: The detection rate of depressive symptoms among adolescents in a district of Chongqing was 17.3%, and the total score of depression scale was (12.02±6.72). There were statistically significant differences in the inefficiency subscale score of boys across stages of genital, pubic hair, armpit hair and beard, and whether the first spermatorrhea has occurred( t/F =7.08，5.46，5.18，4.21，5.84， P <0.05), while significant differences were found in the anhedonia and inefficiency subscales scores among girls across different stages of breast, pubic hair and armpit hair, and whether menarche has occurred( t/F =19.43，4.92，3.98，7.35， P <0.05). Multivariate Logistic regression analysis showed that the absence of first spermatorrhea and menarche were associated with lower prevalence of depressive symptoms in boys and girls ( OR=0.60, 95%CI=0.36-0.98; OR=0.46, 95%CI =0.22-1.00), while pubic hair development was associated with higher prevalence of depressive symptoms in girls ( OR=9.58, 95%CI =1.28- 71.71 ). Conclusion The detection rate of depressive symptoms among adolescents is relatively low. Boys who have had the first spermatorrhea, and girls with advanced pubic hair development or have had menarche are more likely to suffer from depressive symptoms.

Objective: To explore the relationship between the emotional and behavioral problems and family relations of firstborn children from an urban area of Chongqing during the role transition period, to provide a scientific basis for creating a good family relationship and to reduce the occurrence of children s emotional behavior problems. Methods: Totally 1 359 mothers of children in the role transition period were recruited from obstetric clinics at two Grade A hospitals in Chongqing, and mothers with informed consent using self designed questionnaire and parental version of the Child Behavior Checklist (CBCL). It was analyzed the association between family relationships and the emotional/behavioral problems of firstborn children of different ages. SPSS statistical software (version 20) was used for the descriptive statistical analysis, chi square test, and multiple linear regression analysis. Results: The parental relationship (56.6%), mother child relationship (80.4%) and father child relationship (64.9%) of most firstborn children was good, and 61.7% of families enjoyed a harmonious atmosphere. For the age groups 1.5-5 years and 6-13 years, the respective CBCL total scores were (18.22±13.63) and (24.20±17.52), and the detection rates were 10.7% and 10.5%, respectively. The results of the multiple linear regression analysis showed that, for both age groups, firstborn children who had good parental relationships, good mother child relationships, good father child relationships, and a harmonious family atmosphere exhibited fewer internalizing, externalizing and overall emotional behavior problems ( P <0.05). Conclusion The total detection rate of emotional and behavioral problems among firstborn children in the role transition period, which is low. Good parental relationships, good parent child relationships, and a harmonious family atmosphere are protective factors against emotional and behavioral disorders in firstborn children during the role transition period.