Objective:This study aims to evaluate the clinical efficacy and safety of Dibai Yijing Formula(DYF)in the treat-ment of male infertility with essence deficiency in the kidney and damp-heat in the essence chamber(Abbreviation:kidney deficiency and damp-heat type).Methods:This study employed a randomized,controlled clinical trial design,recruiting 72 male patients with infertility due to kidney deficiency and damp-heat type.Patients were randomly assigned to an treatment group(36 patients)and a control group(36 patients)using a random number table.The control group received oral Clomiphene Citrate Capsules(50 mg,twice daily),while the treatment group received oral DYF(one dose daily,200 ml each time,30 minutes after breakfast and dinner).Both groups underwent a 12-week treatment period.After treatment,sperm concentration(SC),percentage of progressively motile sperms(PR),total sperm motility[PR+percentage of non-progressively motile sperms(NP)],and semen volume(SV)were compared between the two groups before and after treatment.Additionally,the total score of Traditional Chinese Medicine(TCM)syndrome score and sperm DNA fragmentation index(DFI)and pregnancy outcomes of the patients'spouses were compared between the two groups.Results:Three patients dropped out from the treatment group and four from the control group.There were no statistically sig-nificant differences in semen parameters between the two groups(P＞0.05).After treatment,the patients in the treatment group showed significant difference in the percentage of SC([19.42±5.30]x 106/ml vs[10.75±2.41]x 106/ml),PR([27.72±6.62]％vs[20.04±4.10]％),PR+NP([49.86±10.68]％vs(33.74±5.58)％],DFI([12.33±3.43]％vs[15.06±3.98]％)and TCM symtom score([7.45±1.82]vs[13.85±1.91]),and the difference was statistically significant(P＜0.05).The patients in the control group showed significant difference in the percentage of SC([19.56±5.24]× 106/ml vs[11.31±2.08]× 106/ml)and TCM symptom score([12.81±1.86]vs[14.06±1.64]).But no significant changes were observed in the PR([21.75±5.93]％vs[20.05±4.67]％),PR+NP([34.23±7.15]％vs[32.35±4.09]％),SV([3.19±1.08]ml vs[3.12±1.13]ml),and DFI([15.11±4.76]％vs[15.51±4.35]％)were not statistically significant(P＞0.05).Improve-ments in PR,PR+NP,TCM symptom score and DFI in the treatment group were better than those in the control group after treatment(P＜0.05);the differences in SC and SV and spousal pregnancy in the treatment group were not statistically significant compared with those in the control group(P＞0.05).No serious adverse events occurred in both groups during the treatment period.Conclusion:The treatment of male infertility with DYF is effective and safe.

Objective:To investigate the care needs and influencing factors for caregivers of children with disabilities. Methods:From December, 2019 to January, 2020, and August to September, 2020, a total of 496 family caregivers of children with disabilities were surveyed in Shanghai. The Care Needs Assessment Tool for Children with Disabilities was used to measure the care needs rates and satisfaction, and multiple linear regression was performed to analyze the related factors. Results:The rate of total need was 71.8%, which was high in the information support (83.7%), spiritual support (75.9%) and financial support (74.1%), and was at an intermediate level in alternative service support (62.9%) and professional support (62.2%). The satisfaction of total need was 39.4%, which was at a intermediate level in the spiritual support (50.8%) and professional support (45.5%), and was at a low level in alternative service support (32.8%), financial support (32.3%) and information support (30.3%). The caregivers needed less support for thoses with higher public policy satisfaction (B = -3.252, 95%CI -5.370 to -1.134, P = 0.003) and the children with vision and speech disability, and undetermined disability (B_{vision disability}= -12.160, 95%CI -21.976 to -2.344, P = 0.015; B_{speech disability}= -12.754, 95%CI -22.583 to -2.925, P = 0.011; B_{undetermined disability}= -16.553, 95%CI -24.714 to -8.392, P < 0.001), while mothers (B = 9.071, 95%CI 4.293 to 13.848, P < 0.001) needed more support than grandparents. The caregivers with higher public policy satisfaction (B = 7.392, 95%CI 5.523 to 9.262, P < 0.001), the children with vision disability, hearing disability and speech disability (B_{vision disability}= 8.612, 95%CI 0.081 to 17.144, P = 0.048; B_{hearing disability}= 8.686, 95%CI 1.920 to 15.451, P=0.012; B_{speech disability}= 9.515, 95%CI 1.184 to 17.846, P = 0.025), lower barriers to social inclusion (B = 1.932, 95%CI 0.457 to 3.408, P = 0.010) and shorter average daily care hours (B = -4.123, 95%CI -6.247 to -1.999, P < 0.001) were more satisfactory for support. Conclusion:The care needs of children with disabilities are diverse, with the highest rate of need for information support and the lowest level of satisfaction. There is some variation in the care needs of children with different types of disabilities, family roles, average daily care hours and social environment characteristics.

Objective:To explore the nutritional status and influencing factors among children with disabilities in developed areas. Methods:From December, 2019 to January, 2020, and August to September, 2020, a total of 480 caregivers of children with disabilities aged two to 18 years in Shanghai were investigated their heights and weights, and the body mass index (BMI) was calculated. The influencing factors were analyzed from the dimensions of children's personal, family and social characteristics based on the Ecological System Theory. Chi-square test and binary Logistic regression model were used to analyze the influencing factors associated with the nutritional status of children with disabilities. Results:The prevalence of thinness, overweight and obesity in 480 children was 23.75%, 13.54% and 13.33%, respectively. Multivariate Logistic regression analysis showed that potato intake (OR = 0.420, 95%CI 0.197 to 0.893, P < 0.05) and caregivers' perception of child's weight (OR _underweight = 4.188, 95%CI 1.488 to 11.787, P < 0.01) were associated with children's thinness. Types of disability (OR _autism= 0.142, 95%CI 0.034 to 0.591, P < 0.01), the role of caregiver (OR _father= 5.519, 95%CI 1.110 to 27.440, P < 0.05), and caregivers' perception of the child's weight (OR _overweight = 5.669, 95%CI 1.112 to 28.903, P < 0.05) were associated with children's overweight/obesity. Conclusion:The prevalence of malnutrition among children with disabilities in Shanghai is higher than those typically-developing, especially thinness and obesity. The nutritional status is greatly affected by the type of disability, dietary intake and family characteristics.

Objective:To explore the quality of life of caregivers of children with disabilities and its influencing factors. Methods:From December, 2019 to January, 2020, and August to September, 2020, a total of 496 family caregivers of children with disabilities were surveyed in Shanghai. The 12-item Short-form Health Survey (SF-12) was used to measure the quality of life of 496 caregivers, and multiple linear regression was performed to analyze the related factors. Results:The score of physical component summary (PCS) of caregivers was (51.67±8.11), and the score of mental component summary (MCS) was (42.10±12.66). The scores of PCS were lower in caregivers with children aged 6 to 18 years (B = -1.783, 95%CI -3.279 to -0.287, P = 0.020), children with emotional instability (B = 2.719, 95%CI 1.254 to 4.184, P < 0.001), female caregivers (B = -3.765, 95%CI -6.578 to -0.953, P = 0.009), and caregivers who were relatively dissatisfied with the policy (B = 1.973, 95%CI 0.367 to 3.578, P = 0.016); and were higher in caregivers with children with speech disabilities (B = 3.463, 95%CI 0.053 to 6.873, P = 0.047). The types of disabilities of children (B_hearing = 9.465, 95%CI 5.107 to 13.823, P < 0.001; B_undetermined = 5.999, 95%CI 1.558 to 10.441, P = 0.008), playmates of children (B = 2.626, 95%CI 0.352 to 4.901, P = 0.024), education level of caregivers (B_{high middle school} = -4.701, 95%CI -8.028 to -1.374, P = 0.006; B_{high school} = -3.610, 95%CI -6.604 to -0.615, P = 0.018), family size (B = 2.616, 95%CI 0.479 to 4.753, P = 0.017) and per capita monthly income (B _{< 5000 Yuan}= -6.572, 95%CI -9.136 to -4.008, P < 0.001; B_{5000 to < 10000 Yuan} = -4.932, 95%CI -7.544 to -2.319, P < 0.001) were associated with the scores of MCS. Conclusion:The quality of life, especially the mental health, of caregivers of children with disabilities is poor. The influencing factors cover multiple dimensions such as caregivers, children, family and social environment.

Objective:To investigate the anxiety state and its influencing factors for caregivers of children with disabilities. Methods:From December, 2019 to January, 2020, and August to September, 2020, a total of 496 family caregivers of children with disabilities were surveyed in Shanghai. Crosstab was used to analyze the anxiety state and binary logistic regression analysis was used for identifying key factors. Results:There were 73.2% parents and 26.8% grandparents among 496 caregivers. Physical disabilities accounted most (26.0%) in the children. About 35.1% caregivers reported their anxiety state, and more than 10% reported moderate to severe anxiety. The results of logistic regression analysis showed that grandfather reported 0.318 times anxiety to mother (OR = 0.318, 95%CI 0.113 to 0.900, P = 0.031). Sleep problems (OR = 1.713, 95%CI 1.046 to 2.805, P = 0.032) and emotional functioning (OR_generally = 0.057, 95%CI 0.009 to 0.340, P = 0.002; OR_stable = 0.031, 95%CI 0.005 to 0.205, P < 0.001) of children were associated with the rate of caregiver-reported anxiety. Among family environment factors, monthly per capita household income (OR_{5000-< 10000 Yuan} = 0.463, 95%CI 0.236 to 0.909, P = 0.025; OR_{≥ 10,000 Yuan} = 0.325, 95%CI 0.160 to 0.660, P = 0.002) and housing status (OR = 0.356, 95%CI 0.208 to 0.608, P < 0.001) were associated with the rate of caregiver-reported anxiety. Among social environment factors, caregivers who were satisfied with current accessibility reported lower rate of anxiety (OR_satisfied = 0.136, 95%CI 0.031 to 0.602, P = 0.009). Conclusion:The anxiety state of caregivers of children with disabilities is higher than that of the general population. When caregivers are caring for a child with sleep problem or emotional issue, have low household income, or dissatisfied with the barrier-free environment, they may face higher risk of anxiety.

Objectives:To systematically analyze the framework and contents of World Health Organization (WHO) policy and action strategies on rehabilitation using the theory of WHO health service components, to explore the theoretical bases, methodology, framework and core elements of WHO's international rehabilitation policy. Methods:WHO has launched rehabilitation-related policy documents, mainly including Rehabilitation in Health Systems, Rehabilitation in Health Systems: Guide for Action, Rehabilitation Indicator Menu: a tool accompanying the Framework for Rehabilitation Monitoring and Evaluation (FRAME), Template for Rehabilitation Information Collection (TRIC): a tool accompanying the Systematic Assessment of Rehabilitation Situation (STARS), and established systems of international rehabilitation policy architecture system. Using content analysis, this study analyzed in detail the theoretical basis and methodology of international rehabilitation policy, the policy framework, and the core elements of the action strategy and priority areas of rehabilitation service development in perspective of WHO six building blocks of health system, namely leadership and governance, financing, human resources for health, service delivery, medical technology, and health information systems. Results:WHO rehabilitation policy is developed based on WHO's theories of person-centered health services, social determinants of health, and functioning, disability and health of International Classification of Functioning, Disability and Health. WHO rehabilitation policy recognized that the development of rehabilitation was an important pathway achieving United Nations 2030 Sustainable Development Goals 3, ensure healthy lives and promote well-being for all at all ages, i.e. Unlversal Health Coverage. This paper systematically analyzed WHO's international policy framework, action strategies, and development areas, content and priorities in six major areas: leadership and governance, financing, human resources for health, service delivery, medicine and technology, and health information systems. WHO rehabilitation policies advocates to develop national rehabilitation plans, to establish and improve rehabilitation leaderships and the development of mechanism and capacity of rehabilitation governance, to develop multiple approaches of rehabilitation financing, to integrate rehabilitation into health service system, provides different levels of rehabilitation services in the health service continuum, and to build networks of service delivery, to train professionals, to foster rehabilitation information system within health system, to enhance service quality and service coverage, to focus on key areas and priority programs to meet the diverse needs of different populations, and achieve universal health coverage; to include assistive technology into the rehabilitation service system as a field of medicine and technology; and to collect information on functioning and rehabilitation needs, outcomes and impacts of rehabilitation services in the health information system, and conduct evidence-based researches on rehabilitation systems. Conclusion:The framework and contents of WHO's international rehabilitation policies have systematically reviewed at the macro, meso, and micro levels with the perspective of WHO six building blocks of the health system. The goal of rehabilitation development is to achieve universal rehabilitation coverage. The conceptual theories of rehabilitation are based on the theories of people-centered health services and social determinants of health. Rehabilitation is an important initiative to achieve the United Nations 2030 Sustainable Development Goals. The international rehabilitation health policy system is built on six major areas of rehabilitation: leadership and governance, rehabilitation financing, rehabilitation human resources, rehabilitation service delivery, rehabilitation-related medicine and technology, and rehabilitation and health information system. The policy and action strategies for rehabilitation development, as well as specific implementation paths and methods, at macro, meso and micro levels: theory and policy, policy action, and implementation methods and tools have been reviewed and discussed. The implementation of the WHO rehabilitation policies advocates to take the following actions: strengthening the leadership, governance, planning and coordination capacity of rehabilitation services; constructing a reasonable rehabilitation financing mechanism and raising necessary funds for rehabilitation; improving the training and guarantee mechanism of rehabilitation human resources; enhancing the professional capacity of rehabilitation personnel, improving the capacity of rehabilitation service delivery and improving service quality; improving the quality and accessibility of assistive products and assistive technology services; establishing health information system covering functioning, disability and rehabilitation, and conducting scientific researches on rehabilitation.

This paper explored the background, framework and approach, contents and implementation of WHO Rehabilitation in Health System using approaches of ICF and WHO Handbook for Guideline Development. The actions and significances of implementations of seven recommendations and one good practice statements on assistive products had been discussed.

Objective To analyze the protective effect of luteolin on the pancreas of mice with severe acute pancreatitis and to explore its possible molecular mechanism. Methods Sixty healthy male C57/ BL mice of SPF grade were divided into three groups according to the random number table method, the control group, the severe acute pancreatitis (SAP) model group and the treatment group, 20 cases in each group. The model was established by the caerulein method. The levels of lipase, amylase, heme oxygenase (HO)-1, tumor necrosis factor (TNF)-α, malondialdehyde(MDA)and superoxide dismutase(SOD)were measured by ELASA method . The protein and mRNA levels of nuclear factor(NF)-κB, P38 and p-P38 in each group were determined by Western blotting and Real-time PCR. Results Compared with the control group, the pancreas dry-wet weight ratio, lipase and amylase, inflammatory factors HO-1, TNF-α levels, oxidative stress index MDA levels increased significantly, while SOD levels were significantly lower in the model group and the treatment group (P<0. 05). Compared with the model group, the pancreas dry-wet weight ratio, lipase and amylase, TNF-α and MDA levels in the treated group decreased significantly, while HO-1 and SOD levels increased significantly (P<0. 05). Compared with the control group, the levels of NF-κB and p-P38 protein and mRNA in the model group and the treatment group increased significantly (P<0. 05), and there was no significant change in P38 mRNA protein and expression level (P>0. 05). Compared with the model mice, the levels of NF-κB, p-P38 protein and mRNA in the treated group decreased significantly (P<0. 05). Conclusion Luteolin has a protective effect on SAP mice. Its possible molecular mechanism is to relieve inflammatory stress and oxidative stress, and down-regulate the expression of NF-κB and p-P38 protein.

Objective To evaluate the efficacy of rituximab in treating chronic lymphocytic leukemia (CLL). Methods The clinical data of CLL patients receiving fludarabine,cyclophosphamide±rituximab (with or without rituximab) regimen or cyclophosphamide,vincristine,and prednisone±doxorubicin±rituximab regimen in our hospital from March 2000 to February 2015 were analyzed retrospectively. Therapeutic efficacies and survivals of patients treated with different regimens were evaluated and compared. Results The complete response (CR) rate and the overall response rate (ORR) in 72 patients (43.6%) treated with rituximab were significantly higher than those treated without rituximab (38.9% vs. 21.5%,P=0.015;83.3% vs. 60.2%,P=0.001). The median PFS and OS for patients treated with rituximab were 53.0 (27.0-79.0) months and 112.0 (81.1-142.9) months,and the median PFS and OS for patients treated without rituximab were 28.0 (18.3-37.7) months and 89.0(72.0-106.0),but the results were not statistically significant (P=0.094,P=0.109). According to the cytogenetic features,patients were further divided into high-risk subgroup (with chromosome 17p deletion or 11q deletion) and non-high-risk subgroup. And in the high-risk subgroup,the ORR of patients treated with rituximab was 86.4%,which was significantly higher than that in patients treated without rituximab (53.3%)(P=0.012);in the non-high-risk subgroup,the PFS was marginally prolonged in patients treated with rituximab,but the difference was not statistically significant(P=0.050). Conclusions Compared with traditional chemotherapy,the chemoimmunotherapies with rituximab result in higher CR rate and ORR in CLL patients. In patients without 17p deletion or 11q deletion,the use of rituximab can marginally prolong PFS.

Objective To study the effects of environmental factors,including high temperature,high humidity and low temprtature,on the quality of whole blood.Methods Fresh blood was collected from 9 blood donors and divided into 40 parts.One group that comprised 20 samples was used to assess the effects of storage at high temperature and high humidity (0,3,6,12 and 24 h),and the other group(20 samples)was used to determine the effects of low temprtature(0,1,2 and 3 h).The serum free hemoglobin(FHb)concentration, plasma prothrombin time(PT), activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)were measured and analyzed.Results The high temperature(27-37℃)and humidity(60%-90%RH)had no effect on FHb, PT, APTT, TT or FIB of whole blood. The low temperature(0-13℃and -18--20℃)had some effect on the quality of whole blood.The FHb of test group was higher than that of control group.There was no significant difference in PT, APTT, TT and FIB between the two groups.Conclusion Under high temperature and humidity conditions, 24 hours of whole blood placement is feasible. Under low temperature or cold conditions,short-term whole blood placement is feasible in a tent with heating facilities.