Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

The concept of membrane anatomy has been widely accepted and applied in clinical practice, but there are still many theoretical and practical conflicts. This article elucidates the fundamental concepts and manifestations of membrane anatomy, delineating its comprehensive integration of anatomical and surgical disciplines. Thereafter, this article specifically discusses its differences from the traditional anatomy and surgery, and then clarifies the important role of membrane anatomy as the third generation of surgical anatomy and the new surgical concept for the development of pelvic surgery.

The concept of membrane anatomy has been widely accepted and applied in clinical practice, but there are still many theoretical and practical conflicts. This article elucidates the fundamental concepts and manifestations of membrane anatomy, delineating its comprehensive integration of anatomical and surgical disciplines. Thereafter, this article specifically discusses its differences from the traditional anatomy and surgery, and then clarifies the important role of membrane anatomy as the third generation of surgical anatomy and the new surgical concept for the development of pelvic surgery.

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

Objective:To investigate the effects of meditation therapy on fear of disease progress and mental health among acute myocardial infarction (AMI) patients.Methods:Totally, 120 cases of acute myocardial infarction patients admitted to Affiliated Hospital of Jiangnan University were divided into experimental group and control group according to the enrolled time. 60 patients with AMI treated from June to November 2018 served as the control group and 60 patients with AMI treated from January to May 2019 served as the experimental group. The patients in the control group received routine nursing, the experimental group carried out 4-week meditation therapy based on the routine nursing. Before and after intervention, the effect was assessed by Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and Symptom Checklist-90 (SCL-90), respectively.Results:After intervention, the physical health and social family function dimension scores in FoP-Q-SF as well as total FoP-Q-SF scores were (12.78±3.47), (10.45±2.44), (23.24±4.25) points, significantly lower than in the control group (14.33±2.72), (11.59±2.82), (25.91±3.89) points, the difference was statistically significant ( t values were 2.623, 2.277, 3.499, P<0.05); the scores of somatization, compulsion, anxiety, depression and total SCL-90 were (1.26±0.19), (1.42±0.23), (1.19±0.28), (1.20±0.16) and (121.81±9.59) points, significantly lower than (1.83±0.25), (1.68±0.37), (1.82±0.41), (1.71±0.33) and (145.85±9.12) points in the control group, the difference was statistically significant ( t values were from 4.580 to 13.659, P<0.001). Conclusion:Meditation therapy can effectively decrease disease progress and promote mental health in patients with acute myocardial infarction.

Objective: To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV) infection in children from six provinces (autonomous region) in northern China. Methods: A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces(autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong. Results: The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months -17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted > 3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 9%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate(19%,4/21), procalcitonin(4%,1/28), liver enzyme(22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred. Conclusions In this case series, 2019-nCoV infections in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis. After general treatment, the short-term prognosis is good.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Objective To evaluate the optimum compatibility of nalbufine combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section.Methods A total of 100 parturients who were at full term with a singleton fetus,aged 24-35 yr,with body mass index of 29-33 kg/m2,of American society of Anesthesiologists physical status Ⅱ,scheduled for elective cesarean section under combined spinal-epidural anesthesia,were divided into 4 groups (n =25 each) using a random number table method:sufentanil 0.5 μg/ml plus 0.15％ ropivacaine group (SR group),nalbufine at final concentration of 0.2 mg/ml plus 0.15％ ropivacaine group (N1 R group),nalbufine at final concentration of 0.4 mg/ml plus 0.15％ ropivacaine group (N2R group) and nalbufine at final concentration of 0.4 mg/ml plus 0.1％ ropivacaine group (N3Rgroup).PCEA solution was prepared correspondingly after surgery,and all the drugs were diluted to 100 ml in normal saline in each group.The PCA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analog scale scores of incisional pain and anduterine contraction pain were maintained＜4.Ramsay sedation scores were recorded at 8,12,24 and 48 h after surgery.The total pressing times of PCEA were recorded within 48 h after surgery.The development of adverse reactions such as nausea,vomiting,skin itching,numbness of lower extremity,urinary retention and respiratory depression was recorded in the analgesia period.Venous blood samples were collected before surgery and at 24 and 48 h after surgery for determination of plasma prolactin concentrations,and the time of colostrum was recorded.Neonatal nerve and adaptive capacity was assessed and scored.Results Compared with group SR,the total pressing times of PCEA were significantly reduced in N2R and N3R groups (P＜0.05),and no significant change was found in the total pressing times of PCEA in group N1R (P＞0.05).Compared with group N1R,the total pressing times of PCEA were significantly reduced in N2R and N3 R groups (P＜0.05).There was no significant difference in the total pressing times of PCEA between group N2R and group N3R (P＞0.05).The Ramsay sedation score was 2 in four groups.There was no significant difference in numbness of lower extremity,plasma prolactin concentrations or neonatal nerve and adaptive capacity scores among four groups (P＞0.05).Conclusion Nalbufine at final concentraction of 0.4 mg/ml mixed with 0.1％ ropivacaine is the optimum compatibility when used for PCEA after cesarean section.

OBJECTIVE： To establish performance management system that can effectively guide the realization of pharmacist value. METHODS： Using action learning method， through continuous questioning， reflection and execution to establish a step-by-step and in-depth pharmacist performance management system in our hospital. The effects of performance management system were evaluated with outpatient service satisfaction and the times of pharmacist consultation. RESULTS： From 2013 to 2018， the performance management system was established， involving team performance （taking the results of team quality control inspection at the end of the month and the monthly work report of team leaders as indicators）/personal performance （taking pharmacist’s performance， work attitude and ability as indicators）/post competency （change of assessment indicators with the position of pharmacist， examination of clinical pharmacists drug counseling， etc） 3 levels. The establishment of performance management improved team enthusiasm and service satisfaction， optimized the talent structure， enlarged the professional ability and influence of pharmacists， and improved the income structure of pharmacists. Compared with 2013， outpatient service satisfaction increased from 88％ to 95％ in 2018. Compared with 2016， the times of pharmacist consultation increased from 30 to 92 in 2018. Pharmacists could increase their income by providing pharmaceutical services to clinical departments. CONCLUSIONS： The established pharmacist performance management system can effectively improve the enthusiasm of pharmacists and promote the work of pharmacists.

Objective: To explore the effect of metabolic syndrome(MetS) and its individual components on cognitive impairment and neurological dysfunction in patients after acute ischemic stroke. Methods: A total of 733 patients with acute ischemic stroke aged 60 to 83 years admitted in Tianjin Huanhu hospital from January 2010 to May 2018 were enrolled in this cross-sectional study.The patients were divided into the non-metabolic syndrome(non-MetS) group and the metabolic syndrome(MetS) group according to the diagnostic criteria of metabolic syndrome.Cognitive functions were evaluated by using the Montreal Cognitive Assessment(MoCA) and Mini-Mental State Examination(MMSE). Neuropsychiatric behavior was assessed by using the Neuropsychiatric Inventory(NPI) questionnaire.Emotional state was examined according to the 21-item Hamilton Depression Rating Scale(HAMD-21). The degree of neurological impairment after stroke was evaluated by using the National Institutes of Health Stroke Scale(NIHSS). The activity of daily living was evaluated by Barthel index and the Activity of Daily Living(ADL) scale.The overnight fasting blood samples were obtained in order to determine biochemical indicators. Results: The average age of first-onset of ischemic stroke was earlier, and the body mass index(BMI) was higher in the MetS group than in the non-MetS group(P<0.05). The levels of high sensitivity C-reactive protein(hs-CRP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), homocysteine(Hcy), fasting plasma glucose(FPG) and haemoglobin A1c(HbA1c) were higher, and the level of high-density lipoprotein cholesterol(HDL-C) was lower in the MetS group than in the non-MetS group(P<0.05). In addition, the proportions of patients with hypertension, type 2 diabetes and smokers were higher in the MetS group than in the non-MetS group(P<0.05). The scores of MMSE, MoCA and BI were lower and the scores of NIHSS, NPI-Q and HADM-21 were higher in the MetS group than in the non-MetS group.MetS could increase the risk of cognitive impairment in patients after acute ischemic stroke(OR=3.169, 95% CI: 1.110-9.048). After adjusting for socio-demographic and clinical covariates, the estimated OR value for increasing the risk of cognitive impairment was further increased in MetS(OR=4.741, 95% CI: 2.027-7.427). Furthermore, the increased numbers of MetS components were significantly associated with the cognitive impairment in patients after stroke.With the increasing number of MetS components, the scores of MoCA and BI were decreased, and the scores of ADL, NIHSS, NPI-Q, HADM-21 and Hachinski ischemic scale(HIS) were increased.With the increasing number of MetS components, the degree of neurological impairment and the risk of injury were increased. Conclusions MetS is associated with the decline of cognitive function, neuromotor dysfunction and the increased risk for neuropsychological disorders in patients after acute ischemic stroke.