Objective To explore the effect of a phased rehabilitation training programme to relieve shoulder dys-function in patients after neck dissection and to provide effective solutions for postoperative shoulder joint function recov-ery of patients.Methods This study has been reviewed and approved by the Ethics Committee,and informed consent has been obtained from patients.A phased rehabilitaiton training programme for the shoulder after neck dessection was developed through literature review and discussion,and 70 eligible patients from Hospital of Stomatology,Sun Yat-sen University from December 2020 to April 2021 were selected and randomly divided into the test group and control group(35 patients in each group).The control group underwent motor rehabilitation training from 6 weeks postoperative to 1 year after surgery,such as shoulder mobility and coordination training and small range of motion training of the neck,while the test group took part in a rehabilitation training program that included familiarization maneuver training,protective rehabilitation,exercise rehabilitation,and resistance training in the following four stages:preoperative,postop-erative general anesthesia and awake until the removal of stitches,the removal of stitches until 6 weeks after surgery,and 6 weeks after surgery until 1 year after surgery.The frequency of training in both groups was at least 3 days per week,and the length of each training session was 10-15 min.The intensity of exercise was 2-3 points on the Borg Conscious Ex-ercise Intensity Scale(i.e.,mild-to-moderate tachypnea or fatigue).The neck dissection injury index(NDII)was used to evaluate the quality of life related to shoulder joint function at four time points:preoperative,postoperative 3 months,postoperative 6 months,and postoperative 12 months.The higher the score,the better the quality of life.Results 28 cases in the test group and 32 cases in the control group completed a one-year follow-up.At 3 and 6 months postopera-tive,the NDII of the test group was significantly higher than that of the control group[3 months postoperative:test group(93.48±9.36)vs.control group(80.00±11.34)(P＜0.001),6 months postoperative:test group(98.21±4.76)vs.control group(90.70±9.12)(P＜0.001)];12 months after surgery,the NDII of the test group(97.23±4.88)was still higher than that of the control group(96.33±4.49),but the difference was not statistically significant(P=0.458).The difference in NDII scores among subjects at 3,6,and 12 months after surgery was statistically significant in each group(P＜0.001).Conclusion The application of the phased rehabilitation training method in neck dissection patients has a feasibility and could improve the quality of life of patients'shoulder joint function within 6 months after surgery.

Objective To analyze the hot spots,rules and distribution on safety research of inhalation preparations at home and abroad in the past 20 years,and to summarize the current status of safety and risk control research on inhalation preparations.Methods This reaserch is based on the literature related to the safety and risk control of inhalation preparations in the core collection database of the Web of Science.With the help of Excel 2021 and CiteSpace6.1.R3,visualized processing and analysis were carried out on the annual number of publications,countries,institutions,authors,co-occurrence of keywords,clustering and prominence.Results A total of 365 articles were included,the annual publication number in the field of the safety and risk control of inhalation preparations was less than 30 per year from 2002 to 2018.But since 2019,the number of articles published this year has exceeded 30.Through the analysis of the cooperation network of countries and institutions,the top four countries in terms of publication volume are the United States,the United Kingdom,Germany,and China,and the top three institutions are AstraZeneca,GlaxoSmithKline and Pfizer.Through the analysis of the author cooperation network,the cooperation network between European and American authors was formed earlier,and a certain research group has appeared in 2002.In contrast,a more concentrated cooperation network has been formed in China in 2020.Conclusions In the past 20 years,the research on inhalation preparations has mainly focused on their safety and efficacy,while there are few studies on their risk control.There is a disconnect between safety assessment and risk assessment,and the future focus maybe focused on the adverse reaction assessment and risk management research of inhalation preparations.

Over the past decade, traditional Chinese medicine (TCM) has widely embraced systems biology and its various data integration approaches to promote its modernization. Thus, integrative pharmacology-based traditional Chinese medicine (TCMIP) was proposed as a paradigm shift in TCM. This review focuses on the presentation of this novel concept and the main research contents, methodologies and applications of TCMIP. First, TCMIP is an interdisciplinary science that can establish qualitative and quantitative pharmacokinetics-pharmacodynamics (PK-PD) correlations through the integration of knowledge from multiple disciplines and techniques and from different PK-PD processes

Objective:To investigate the status of innovative behavioral ability of undergraduate nursing students, analyze the relationship between nursing students′ sense of benefit, self-transcendence and innovative behavioral ability, and explore the mediating effect of occupational benefit in self-transcendence and innovative behavioral ability.Methods:A convenient sampling method was used to select 223 undergraduate nursing students in the First Affiliated Hospital of Guangxi University of Chinese Medicine as the research object from October 2017 to April 2019. The cross-sectional survey was conducted using the occupational benefit, self-transcendment scale and nurses′ innovative behavior scale. Apply SPSS21.0 to analyze the correlation between self-transcendence, occupational benefit and innovative behavior of undergraduate nursing students, apply AMOS 22.0 for mediating effect test, and use the bias-corrected percentile Bootstrap method to estimate the median effect of occupational benefit 95% confidence interval.Results:The path coefficient of undergraduate nursing students′ self-transcendence to innovative behavioral ability was significant ( r value was 0.31, P<0.01). Self-transcendence had a significant positive effect on positive occupational sense ( r value was 0.36, P<0.05). The 95% confidence interval for the Bootstrap test of the indirect effect of positive occupationality was 0.02-0.07; the positive sense of occupation had a partial mediating effect between self-transcendence and innovative behavioral ability, with an effect value of 0.14 and a total effect value of 0.42. That was, the mediation effect value accounted for 33.3% of the total effect value. The path coefficient of the team's ability to feel innovative behavior was significant ( r value was 0.39, P<0.05), and self-transcendence had a positive impact on team belonging ( r value was 0.28, P<0.01). The 95% confidence interval for the Bootstrap test for the indirect effects of team belonging was distributed in 0.10-0.42. The sense of belonging of the team had a partial mediating effect between self-transcendence and innovative behavioral ability. The mediating effect value was 0.07, and the total effect value was 0.42, that was, the mediating effect value accounts for 16.7% of the total effect value. Conclusions:Self-transcendence of undergraduate nursing students can directly predict the ability of innovative behavior, and can also indirectly predict the ability of innovative behavior through the mediating role of positive career perception and team belonging in the sense of professional benefit. Improving the professional benefit and self-transcendence of nursing students in clinical teaching may be an effective way to improve the ability of innovative behavior.

Objective:To observe the effect of personalized nutritional support on postoperative rehabilitation and nutritional status in patients undergoing radical mastectomy and reconstruction of oral malignant tumor.Methods:Eighty-eight patients with oral malignant tumor admitted from January 2018 to December 2018 in Hospital of Stomatology, Sun Yat-sen University were divided into two groups according to the time of admission. 40 patients were selected as the study group and 48 patients were selected as the routine group. The routine group was given traditional health education and dietary guidance. In addition to dietary guidance, the study group was given personalized nutritional support according to the patients' body mass index and nutritional status before and after operation, including oral nutritional supplement before operation, personalized nutritional prescription after operation, and increased protein intake according to the nutritional indicators of the patients. The nutritional status, enteral nutrition complications and postoperative rehabilitation were compared between the two groups two weeks after operation.Results:Two weeks after operation, the hemoglobin, total protein, prealbumin were (107.93±16.19) g/L, (68.40±4.87) g/L, (189.02±55.19) mg/L in the study group, and (101.23±14.62) g/L, (63.11±6.42) g/L, (165.75±40.60) mg/L in the routine group, there were significant differences ( t values were -2.037, -4.271, -2.276, all P<0.05). The incidence of malnutrition, wound infection and gastrointestinal complications were 42.50%(17/40), 0, 5.00%(2/40) in the study group and 64.58%(31/48), 16.67%(8/48), 20.83%(10/48) in the control group, there were significant differences( χ2 values were 4.292, 7.333, 4.644, P<0.05). Conclusions:Perioperative personalized nutritional support can effectively improve the nutritional status, reduce enteral nutrition-related complications, improve immunity and reduce the risk of incision infection in patients undergoing radical mastectomy and simultaneous reconstruction of oral malignant tumors, which is helpful to improve the quality of life of patients and is worthy of clinical reference.

Objective: To explore age of menarche and associated factors of Han nationality, Zhuang nationality and Yao nationality girl in Guangxi, and to provide reference for the development of adolescent health education in schools. Methods: The 7-, 10- and 13-year-old girls of Han, Zhuang, Yao nationality were chosed from three counties of Guangxi, and height, weight and other physical indicators were measured for three consecutive years, and age of menarche was inquired. 448 cases of with compete data in the three consecutive years of monitoring. The influencing factors were investigated through questionnaire. Results: Age of menarche of the whole sample was 11.83(95%CI=11.69-11.96)years old, and that of the Han, Zhuang,Yao nationality was 11.87(95%CI=11.64-12.09), 11.44(95%CI=11.25-11.64)and 12.42(95%CI=12.14-12.70)years old respectively, the difference was statistically significant(P<0.05). Height, sitting height, weight of menarche group in 12 and 13 years old were significantly higher those of the group without menarche(P<0.05). Logistic regression analysis primary sitting height,the chest circumference,intake of seafood,duration of sleep in the night and school exercise time were the primary factors for age at menarche(P<0.01). Conclusion There are ethnic differences in age of menarche among girls in Guangxi, and it is related to sleep,physical activity and dietary structure. Puberty recated health education for girls might start at the fourth grade of primary school, focusing on the education of health life patten, balanced dietary habits, regularly routine, with the goal of growth and development promotion.

Objective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .

Objective To explore the value of cytokines and procalcitonin (PCT) in predicting the potential pathogen and the severity of infection in children with hematological malignancies.Methods This was a prospective cohort study.A total of 1 543 children (3 912 episodes) with hematological malignancies admitted to the Department of Hematology/Oncology in Children's Hospital of Zhejiang University School of Medicine from November 2010 to June 2018 were prospectively enrolled in this study.According to the pathogen,the patients were divided into sepsis group with positive blood culture (380 patients/608 episodes),sepsis group with negative blood culture (539/1 484),non-septic infection group (549/1 709),viral infection group (18/21) and fungal infection group (57/90).The patients were also divided into two groups in either shock group (171/187) or non-shock group (1372/3725).Meanwhile,89 children (112 episodes) with matched hematological malignancies without fever were enrolled as the control group.The levels of PCT and cytokines were measured for detecting the potential relationship between these markers and infection severity.Mann-Whitney U test or Kruskal-Wallis H test was used to compare the differences between groups.The Receiver Operator Characteristic curve analysis was used to explore the predictive value.Results (1) There were significantly higher levels of interleukin (IL) 6 (H=210.002,P＜0.01),IL-10 (H=223.045,P＜0.01),and PCT (H=76.799,P＜0.01) in the infection group,with area under curre (AUC) of 0.67 (95％CI 0.64-0.69),0.69 (95％CI 0.66-0.71) and 0.59 (95％CI 0.56-0.61),respectively.(2) Among the patients in the shock group,IL-6 (Z=11.460,P＜0.01),IL-10 (Z=14.242,P＜0.01) and PCT (Z=10.813,P＜0.01) were significantly higher than those in the non-shock group,with the AUC of 0.75 (95％CI 0.70-0.79),0.81 (95％CI 0.77-0.84) and 0.73 (95％CI 0.69-0.77),respectively.(3) In patients with septic shock,the incidence of Gram negative bacteria (GNB) infection (60 episodes) was significantly higher than Gram positive bacteria (GPB) infection (22 episodes) (x2=29.665,P＜0.01).The AUC of IL-6,IL-10 and PCT for predicting GNB infection were 0.75 (95％CI 0.72-0.78),0.82 (95％CI 0.79-0.85) and 0.67 (95％CI 0.63-0.70),respectively.(4) The predictive power of IL-6,IL-10 and PCT combination (AUC=0.994) was superior to IL-10 alone (AUC=0.810) in predicting septic shock (Z=10.211,P＜0.01).Conclusions IL-6and IL-10 are better predictors of GNB infection than PCT in hematology-oncology children.Furthermore,the combination of these two cytokines and PCT is more valuable in predicting the severity of infection.

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare,critical and complicated cyanotic congenital heart disease,the natural mortality rate is high,if not treated,50％ of newborns died within 2 weeks after birth,about 85％ of newborns will die within six months.In recent years,with cardiac surgery procedures,catheter intervention and other treatment levels improved,the survival rate of newborns after surgery has improved.Over the past decade,the disease 5-year survival rate increased by 75％ or more.In this paper,PA/IVS cardiac surgery procedures,catheter intervention and hybrid treatment were reviewed,aimed at providing a reference for clinical treatment.

Objective:To explore the effect of taxifolin on H2O2-induced pyroptosis in H9C2 cells and the possible mechanisms.Methods:The H9C2 cells was divided into 3 groups:a control group,a hydrogen peroxide (H2O2) group and a taxifolin group.The morphology of H9C2 cells was observed by inverted phase contrast microscope.The mitochondrial membrane potential was measured by JC-1 staining and flow cytometry.The alteration of the level of reactive oxygen species (ROS) was detected by specific mitochondrial probe.The protein levels of cysteinyl aspartate specific proteinase-1 (caspase-1) was determined by Western blot.The mRNA levels of interleukin-18 (IL-18),interleukin-1a (IL-1a),interleukin-1b (IL-1b),absent in melanoma 2 (AIM2),apoptosis-associated apeck-like protein (ASC),nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)and nucleotide-binding oligomerization domain-like receptor family caspase recruitment domaincontaining protein 4 (NLRC4) were determined by reverse transcription-polymerase chain reaction (RT-PCR).Results:Compared with the control group,the morphology of H9C2 cells obviously changed in the H2O2-treated group,which was guadually improved in the presence of taxifolin.Compared with the control group,the mitochondrial membrane potential was markedly decreased in the H2O2-treated cells,accompanied by the increase of ROS (both P＜0.05).Compared with the H2O2 group,the mitochondrial membrane potential changes in the taxifolin group was increased while the ROS was decreased,with significant difference (both P＜0.05).Compared with the control group,the protein level of caspase-1 and the mRNA levels of IL-18,IL-1a,IL-1b,AIM2,ASC,NLRP3 and NLRC4 in the H2O2-treated group were significantly increased (all P＜0.05),which were attenuated in the presence of taxifolin (all P＜0.05).Conclusion:Taxifolin can protect H9C2 cells from oxidative injury,and it is able to suppress the H2O2-induced H9C2 cell pyroptosis through inhibition of AIM2,NLRP3 and NLRC4 in flammasome.