Sha （痧） is an acute infectious disease characterised by the appearance of rashes on the skin， caused by exposure to epidemic toxin and pestilent qi. Sha Zhang Yu Heng （《痧胀玉衡》） discussed the treatment principles and methods， and listed collateral bloodletting as one of the main treatments. Through organizing the articles and proved cases， we found that the author believes Sha （痧） is caused by epidemic pathogen， belonging to heat toxin with rapid changes， so timely treatment for qi and blood simultaneously could achieve the effect of transforming qi into defensive qi. Sha Zhang Yu Heng focuses on patient's position during treatmet， the material of the needle， the site of treatment， the quantum of stimulation and the operation of the contraindications and other essentials. According to the depth of the disease location， use traditional Chinese herbal medicine， scraping together to identify the root of the disease. In addition， diet suggestions for the prevention of the recrudescence of disease are also described in detail.

Purpose/Significance To analyze the dynamic changes,influencing factors and weak links of e-health literacy of middle-aged and elderly people,so as to provide references for improving e-health literacy of middle-aged and elderly people.Method/Process A questionnaire survey is conducted among 505 middle-aged and elderly people in Guangzhou,and the results are analyzed by using SPSS 24.0.Result/Conclusion The average score of e-health literacy of middle-aged and elderly people is in the middle level;The weak link of e-health literacy is the lack of health information interaction and evaluation capacity.Individual factors are the primary factors that affect e-health literacy of middle-aged and elderly people.It is suggested to increase policy and financial support,carry out"the younger population helps the aging population"mode,and elderly-oriented transformation of digital health Apps.

Objective:This study aims to explore the impact of various clinical factors on the risk of polymyxin B induced DKI in patients.Methods:This is a single-center retrospective case-control study. A total of 139 patients receiving polymyxin B intravenous treatment in our hospital from January 1 to December 31, 2020 were collected. Baseline variables between polymyxin B induced DKI group and non-DKI group were compared using the Chi-square test or Fisher's exact test for categorical variables and the T-test or Wilcoxon rank sum test for continuous variables, as appropriate. Statistical analysis was performed using univariate and multivariate Logistic regression models, Logistic regression models, multivariate Logistic regression models, Kaplan Meier curve, as well as Log-Rank test.Results:Among a total of 139 patients receiving polymyxin B treatment, 49 cases have experienced DKI, 90 cases did not. The incidence of DKI was 35.25%. There was no statistical difference in general information of age, gender, and proportion of standard weight between the two groups. Among the related indexes of polycolistin B administration, the proportion of high daily dose [>25 000 U/(kg·d)] and the total dosage of medication in the DKI group were both significantly higher than that in the non-DKI group ( P< 0.05, respectively). Among the organ function indexes, there were significant differences in initial serum creatinine, blood urea nitrogen, uric acid, urinary occult blood and urinary specific gravity between DKI group and non-DKI group 48 hours before polymyxin B administration ( P< 0.05). Binary Logistic regression analysis suggested that daily dose and initial creatinine before medication were independent risk factors for DKI caused by polymyxin B ( P< 0.05). Kaplan-meier survival analysis showed that with the accumulation of Polymyxin B administration, the higher the daily dose of Polymyxin B was, the faster the DKI occurred (Log-Rank P= 0.0194). Conclusions:Using intravenous polymyxin B is associated with the risk of DKI, among which higher initial blood creatinine values and higher daily doses are independent risk factors for DKI.

ObjectiveTo investigate the relationship between lower limb muscle strength and walking speed in older adults, and to analyze the mediating role of flexibility and dynamic balance. MethodsFrom November to December, 2021, a total of 155 older adults at the Shanghai Senior Sports and Health Home were included. Their basic health information was collected, and the lower limb muscle strength, flexibility, dynamic balance and walking speed were tested. A mediated effects analysis was conducted. ResultsThere was a pairwise correlation among lower limb muscle strength, flexibility, dynamic balance and walking speed in older adults (r > 0.210, P < 0.01). In the mediated effects model, after controlling for age and gender, lower limb muscle strength did not directly predict walking speed in older adults (β = 0.029, P = 0.699), however, lower limb muscle strength could influence walking speed through the partial mediation of dynamic balance (effect = 0.0130, 95% CI 0.0073~0.0197) and the chain mediation of lower flexibility and dynamic balance (effect = 0.0019, 95% CI 0.0003~0.0043). ConclusionLower limb muscle strength can indirectly affect walking speed in older adults through the mediators of flexibility and dynamic balance, or the dynamic balance alone.

OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.

Chinese materia medica is the material basis of the development of traditional Chinese medicine， but the rapid growth of the demand for Chinese materia medica resources and environmental deterioration make a large number of wild medicine resources endangered. At present， artificial cultivation of Chinese medicinal materials is the main way to alleviate the contradiction between supply and demand in the market， but the production and quality of medicinal materials are seriously affected by the lack of process control， specialization and fine management in medicinal plant cultivation. Early prediction and evaluation of the growth， yield， diseases and insect pests of medicinal plants is an important technical means to guarantee the yield and quality of Chinese medicinal materials， and effective and non-destructive process monitoring technology is the prerequisite for realizing the modernization of Chinese medicine agriculture. With the advantages of rapid， non-destructive and accurate detection， hyperspectral remote sensing has been widely used in recent years for plant growth information extraction and yield assessment， as well as monitoring crop growth and response to adversity stress， becoming an important technical tool for precision agricultural production such as quality monitoring and pest and disease prevention. Therefore， combined with hyperspectral data processing and analysis methods， the application of hyperspectral remote sensing technology in monitoring plant physiological characteristics， environmental stress， resource investigation and quality inspection of medicinal materials is systematically reviewed， and combined with the characteristics of medicinal plants， the application prospect of hyperspectral remote sensing technology in improving the monitoring ability of production process of Chinese medicinal materials， realizing real-time dynamic monitoring of medicinal materials cultivation， developing early diagnosis technology of pests and diseases for nondestructive detection， and establishing quality traceability of high-quality Chinese medicinal materials is discussed， in order to solve the related problems in precision cultivation of Chinese medicine agriculture by hyperspectral remote sensing technology， and provide new ideas and solutions for the sustainable utilization of Chinese medicine resources and the development of intelligent Chinese medicine agriculture.

Objective:To explore the relationship between soft markers found in the first trimester (11-13 + 6 gestational weeks) ultrasound screening and fetal adverse pregnancy outcomes. Methods:Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020. The types and detection rate of soft markers during the first trimester were compared. The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results:A total of 16 625 fetuses with complete follow-up outcomes were included in the group. Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester, and the first four most frequently occurred were increased nuchal translucency (NT) (2.08%, 345/16 625), echogenic intracardiac focus (EIF) (0.94%, 156/16 625), hypoplasia of fetal nasal bone (0.20%, 34/16 625), single umbilical artery (SUA) (0.19%, 31/16 625). Among 556 fetuses, the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50% (13/40), which was significantly higher than fetuses with single positive soft marker (11.05%, 57/516), and the difference was statistically significant (χ 2=5.055, P<0.001). The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77% (21/26), which was significantly higher than fetuses with isolated positive soft marker (12.08%, 64/530), and the difference was statistically significant (χ 2=90.310, P<0.001). Binary logistic regression analysis showed choroid plexus cyst (CPC), SUA, echogenic bowel (EB), absent/reversed a-wave of ductus venosus, hypoplasia of fetal nasal bone, increased NT, and EIF were closely related to the adverse pregnancy outcomes (all P<0.05). However, there were no significant correlations between tricuspid regurgitation (TR), pyelectasis (PYE) and fetal adverse pregnancy outcomes (all P>0.05). Conclusions:The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes. For multiple positive soft markers or positive soft markers combined with structural abnormalities, more attention should be paid to them and comprehensive evaluation is required to be carried out.

Objective:By establishing the reference intervals of free thyroxine (FT 4), thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPOAb) of pregnant women in different pregnancy in Yangzhou, and analyzing the dynamic trends of each indicator, so as to provide a basis for timely and accurate diagnosis of thyroid disease during pregnancy, and promote prenatal and postnatal care. Methods:Clinical data of 3 726 healthy early (1 747 cases), middle (1 481 cases), and late (498 cases) pregnant women were collected from the Department of Perinatal and Health Care in Yangzhou Women and Children Hospital, the Affiliated Hospital of Yangzhou University Medical College from October 2017 to October 2018. At the same time, data of 407 non-pregnant women in the same period were collected as normal controls. The levels of serum FT 4, TSH and TPOAb in each stage of pregnancy were detected by Beckman automatic chemiluminescence analyzer. The reference interval was established by using the 95% reference value of the bilateral limit, and the differences of early, middle and late pregnancy were compared. Results:There were significant differences in FT 4 levels between early, middle and late stages of pregnancy ( H = 82.56, P < 0.01), with the early stage higher than the middle stage ( P < 0.01) and the middle stage higher than the late stage( P < 0.01). The difference of TSH levels was statistically significant ( H = 91.27, P < 0.01), in which the early stage was lower than the middle stage ( P < 0.01), and the middle stage was lower than the late stage ( P < 0.01). There was a statistically significant difference in TPOAb levels ( H = 30.36, P < 0.01). There was no significant difference between the early stage and the middle stage ( P > 0.05), and the early and middle stages were higher than the late stage ( P < 0.01). The reference intervals of thyroid function index in different pregnancies were, early pregnancy: FT 4 8.28 - 15.66 pmol/L, TSH 0.11 - 4.23 mU/L, TPOAb 0.10 - 16.46 U/ml; middle pregnancy: FT 4 7.38 - 14.36 pmol/L, TSH 0.13 - 4.67 mU/L, TPOAb 0.10 - 18.97 U/ml; and late pregnancy: FT 4 6.33 - 11.39 pmol/L, TSH 0.40 - 3.96 mU/L, TPOAb 0.10 - 6.17 U/ml. Conclusions:There are significant differences in serum thyroid function indicators in different pregnant women. Establishing reference intervals of thyroid function indicators in different stages of pregnancy have important clinical significance for diagnosis of thyroid disease and eugenics.

Objective:To explore the consistency of patients with Hodgkin's Lymphoma (HL) and their families' perception of advance directives (Ads) and analyze the influencing factors to their perception of Ads.Methods:Totally 107 HL patients admitted in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 and 107 corresponding families were selected using convenient sampling. The demographic information of the patients and families as well as the clinical characteristics of the patients were collected. Kappa test was employed to analyze the consistency of the HL patients and their families' perception of Ads. Univariate and multivariate analyses were used to analyze the influencing factors to their perception of Ads.Results:Totally 66.36% (71/107) of the HL patients were willing to formulate Ads, higher than 46.72% (50/107) , the proportion of family members who could comply with the Ads willingness of patients, and the difference was statistically significant (χ 2=8.387, P=0.004) . The Kappa value was 0.222, and the consistency of Ads perception among the HL patients and their families was poor. Logistic regression analysis revealed that age, religious belief, bereavement experience, systemic symptoms, and Eastern Cooperative Oncology Group (ECOG) Performance Status were influencing factors for the HL patients to formulate Ads willingness, while religious belief and bereavement experience were influencing factors for the families to follow the patients' Ads willingness. Conclusions:There is a difference in the perception of Ads between HL patients and their families, and the selection of Ads by family members cannot fully represent the patients themselves; religious beliefs and bereavement experience are common factors affecting the perception of Ads in HL patients and their families.

Objective To investigate the effects of self-efficacy intervention on activities of daily living and outcomes in patients with acute ischemic stroke complicated with white matter lesions (WML).Methods From March 2016 to June 2017,patients with acute ischemic stroke complicated with WML admitted to the Departments of Neurology,the Second People's Hospital of Lianyungang were enrolled prospectively.They were randomly divided into intervention group and control group.The control group received routine treatment and nursing,and the intervention group implemented self-efficacy intervention on the basis of the control group.They were followed up until 90 d after onset.Stroke Self-Efficiency Questionnaire (SSEQ) was used to assess the stroke self-efficacy level.The Barthel Index (BI) was used to assess the activities of daily living (ADL) of the patients.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) were used to assess the outcomes of the patients.Results The SSEQ scores in the intervention group were significantly higher than those at the time of admission and in the control group at 90 d (all P ＜0.01).The BI in the intervention group was significantly higher than that in the control group (66.51 ±22.35 vs.58.41 ±23.17;t =3.473,P =0.001),and the NIHSS score was significantly lower than the control group (5.51 ±2.98 vs.6.95 ±2.94;t =-2.094,P=0.040),and the proportion of patients with good outcomes (mRS score 0-2) was significantly higher than that of the control group (73.7％ vs.56.6％;x2 =4.896,P =0.027).Conclusion For patients with acute ischemic stroke complicated with WML,active self-efficacy intervention could improve the ADL and it was helpful to improve the outcomes of patients.