Objective To study the changes of T lymphocyte subtype levels and serum levels of leukotriene B4 ( LTB4 )in children with acute leukemia (AL). Methods The activity of T lymphocyte subsets:CD3+ T cells,CD4+ T cells,CD8 + T cell levels and NK cell were detected in 40 cases of AL and 40 control by Flow Cytometry(FCM). The serum level of LTB4 was measured by ELISA in all subjects. ResultsCompared with normal control , the percentages of CD3 + T cells ( [ 49.51 ± 6.53 ] ％ vs [ 67.63 ± 5.23 ] ％ ), CD4 + T cells ([22.15±4.87]％ vs [34.43 ±5.07]％),CD8+ T cell ([23.41 ±3.96]％ vs [28. 17 ±4.61]％),NK cell ( [5.41 ± 4.25 ] ％ vs [ 13.10 ± 4.91 ] ％ ) were significantly lower in children AL patients, ( Ps ＜0.01 ). However,the serum levels of LTB4 increased significantly in AL patients compared with normal control ( [ 25.23 ± 6.24 ] ng/L vs [ 8.28 ± 2.53 ] ng/L, P ＜ 0.01 ). ConclusionT lymphocyte subtype and serum level of LTB4 showed significant changes in children AL patients compared with normal control, which revealed an important theoretical basis to AL pathogenesis.

BACKGROUND: Nitric oxide plays an important role in bone metabolism. However, the effects of different doses of L-arginine, nitric oxide substrate, on the healing of osteoporotic fractures remain unclear. OBJECTIVE: To investigate the influence of different doses of L-arginine on the healing of osteoporotic fractures and blood biochemistry in rats. METHODS: A total of 50 female Wistar rats, aged 6-month-old, were randomly divided into sham-surgery (n=10) and osteoporosis (bilateral ovariectomy, n=40). After osteoporosis model was established, left middle femoral fractures were made in al 50 rats, and the osteoporosis group was further divided into four groups, low, middle and high dose of L-arginine, and control groups. The L-arginine groups were intraperitoneal y injected with 1, 3, and 5 mg/kg L-arginine at the second day fol owing surgery, while the control and sham-surgery groups were injected with the same volume of normal saline. At 8 weeks, the lumbar and cal us bone mineral density, serum nitric oxide, and nitric oxide synthase were detected. Meanwhile, the bone cal us histological examination was conducted. RESULTS AND CONCLUSION: During fracture healing, osteoporosis rats showed a low level of serum nitric oxide and nitric oxide synthase compared with normal fractured rats (P < 0.05). L-arginine can improve the concentration of serum nitric oxide and nitric oxide synthase in osteoporosis rats. Moreover, middle dose of L-arginine can increase the cal us and lumbar spine bone mineral density of osteoporosis rats, so the number and continuity of bone trabecula were enhanced. These findings suggest that middle dose of L-arginine (3 mg/kg) can promote healing process of osteoporotic fractures and improve osteoporosis.

Objective To report the clinical and peripheral neuropathological findings in two patients with autosomal recessive Charcot-Marie-Tooth disease 2K(AR-CMT2K).Methods Case one was a nine year-old girl.She had distal weakness of lower limbs for six years, with calf atrophy and contracture of Achilles tendon for three years.Case two was an eight year-old boy.He had distal weakness of lower limbs with contracture of Achilles tendon and calf muscle atrophy for three years, and proximal weakness of low limbs for two years.The motor nerve conduction velocities in median nerves were 48.1 m/s in case one and 47.6 m/s in case two.The compound motor action potential amplitude of median nerves decreased by 46% in case one and 69% in case two.Sural nerve biopsies and gene targeted next-generation sequencing were performed in both patients.Results Density of myelinated fibers was 8 407/mm2 in case one and 7 714/mm2 in case two.The ratio of myelinated fibers with diameter over 8 μm was 2.6% in case one and 0 in case two.Both patients had small regenerating cluster of myelinated fibers.Thin myelinated fibers appeared in case one.In case two, atypical onion bulb formations with focal folded myelin appeared, and electromicroscopy revealed mitochondrial aggregate in axons.Compound heterozygous mutations of ganglioside-induced differentiation associated protein 1 gene were detected in both patients, including c.767A>G(p.H256R) and c.466G>A (p.A156T) in case one and c.767A>G and 845G>A(p.R282H) in case two.Conclusions Contracture of Achilles tendon may appear in early childhood of AR-CMT2K patients.The main pathological changes in sural nerve are loss of large myelinated fibers, mitochondrial aggregate in axons and myelin abnormalities.

Objective:To explore the value of multi-parametric MRI for thyroid gland in differentiating benign and malignant thyroid nodules.Methods:From December 2018 to May 2020, 78 patients with 91 post-surgically pathologically confirmed thyroid nodules were enrolled in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. For each patient, the following MRI findings were obtained including the nodules′ location, size, shape, margin, signal intensity, cystic change, degree and pattern of contrast enhancement, involvement of surrounding structure, and ADC values. The time-intensity curve (TIC) were plotted and subtyped based on dynamic contrast enhancement MRI. The MRI findings between the benign and malignant thyroid nodules were compared using Mann-Whitney U test, χ 2 test or Fisher exact test. Multiple logistic regression analysis was used to select independent predictive variables and build a combined model, and the ROC curve was used to evaluate the diagnostic performance of each MRI finding and the combined model. Results:Between the benign and malignant thyroid nodules, the significant differences were found in size, shape, margin, presence of cystic changes, T 1WI signal intensity, ADC value, enhancement homogeneity, TIC subtypes and presence of thyroid capsule involvement ( P<0.05). Multivariate logistic analysis showed that ill-defined margin (OR=77.61), no presence of cystic changes (OR=36.11) and difference between TIC subtypes (OR=83.41) were independent predictive variables, and the area under the ROC curve (AUC) was 0.879, 0.788, and 0.751, respectively. The AUC, sensitivity and specificity of the combined model were 0.977, 0.986, and 0.904, respectively. Conclusions:Thyroid multi-parametric MRI derived findings can be used for the differential diagnosis of benign and malignant nodules. Combined with the independent risk factors with ill-defined margin, no presence of cystic changes, TIC of type plateau or washout, the diagnostic model has a higher diagnostic efficiency.

This study aims to review the research progress on the effects of repetitive transcranial magnetic stimulation （rTMS） on cognitive function in generalized anxiety disorder （GAD） with the view of providing references for clinical application. As a common chronic mental disorder， GAD affects the cognitive function， the quality of life and social function of patients. Although first-line treatment is safe and effective for the majority of patients， its effect of improving cognitive function is unclear. As a non-invasive and safe physiotherapy technology， rTMS is expected to provide a new option for the clinical treatment of GAD patients. This review focuses on the characteristics of cognitive function of GAD， the current status of first-line therapy and the treatment of rTMS.

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

The advancement of computers and data explosion have ushered in the third wave of artificial intelligence(AI). AI is an interdisciplinary field that encompasses new ideas, new theories, and new technologies, etc. AI has brought convenience to ophthalmology application and promoted its intelligent, precise, and minimally invasive development. At present, AI has been widely applied in various fields of ophthalmology, especially in oculoplastic surgery. AI has made rapid progress in image detection, facial recognition, etc., and its performance and accuracy have even surpassed humans in some aspects. This article reviews the relevant research and applications of AI in oculoplastic surgery, including ptosis, single eyelid, pouch, eyelid mass, and exophthalmos, and discusses the challenges and opportunities faced by AI in oculoplastic surgery, and provides prospects for its future development, aiming to provide new ideas for the development of AI in oculoplastic surgery.

BackgroundIndividuals may experience significant alterations in sleep hygiene during the major public health emergencies， consequently impacting their sleep quality. ObjectiveTo explore the relationship between sleep quality and sleep hygiene among adult residents during the major public health emergencies， so as to provide references for improving the sleep quality of residents during such a period. MethodsA sample of 1 364 adult residents were enrolled as the research subjects from February 20 to 29， 2020. All participants were asked to complete self-administered questionnaire to obtain basic-demographic information and sleep hygiene. Pittsburgh Sleep Quality Index （PSQI） was applied to assess sleep quality. Residents were classified into poor sleepers with PSQI score ≥8 and good sleepers defined as PSQI score <8. Binary Logistic regression analysis was conducted to identify factors associated with sleep quality. Radar chart was used to visualize and compare the sleep hygiene between poor sleepers and good sleepers. ResultsAccording to PSQI score， 891 （65.32%） residents were good sleepers， while 473 （34.68%） residents were poor sleepers. Comparison revealed that age （χ²=3.887）， past medical history （χ²=27.938）， awareness rate of importance of sleeping before major public health emergencies （χ²=4.337）， impact of sleep quality on quality of life during the major public health emergencies （χ²=178.138）， frequency of staying up late during the major public health emergencies （χ²=139.390）， compensatory sleep behaviors （χ²=39.257）， impact of sleep problems on daytime functioning （χ²=285.879）， change of bedtime （χ²=63.031）， sleep latency （χ²=168.672）， wake-up time （χ²=59.221）， changes in sleep duration （χ²=172.332）， time spent in the bedroom （χ²=23.071）， and sum of money spent on improving sleep environment （χ²=58.584） yielded statistical difference between poor sleepers and good sleepers （P<0.05 or 0.01）. Logistic regression analysis denoted that past medical history （OR=1.680， 95% CI： 1.185~2.382）， negative impact of sleep quality on quality life （OR=4.181， 95% CI： 2.722~6.422）， staying up late 3 to 4 times per week （OR=3.145， 95% CI： 1.497~6.605）， staying up late almost every day （OR=4.271， 95% CI： 1.970~9.260）， negative impact of sleep problems on daytime functioning （OR=7.169， 95% CI： 5.188~9.907）， prolonged sleep latency （OR=2.836， 95% CI： 2.019~3.982） and shortened sleep duration （OR=3.518， 95% CI： 2.144~5.772） were risk factors of poor sleep quality. The sum of money spent on improving sleep environment following the major public health emergencies ≤500 RMB （OR=0.334， 95% CI： 0.134~0.830） was related to the incidence rate of poor sleep quality. Radar chart showed that poor sleepers were characterized by extravagant concerns， excessive cleanliness and poor sleep hygiene practices during the major public health emergencies， and poor sleepers were more likely to stay up late due to stress and emotional issues. ConclusionSome residents are facing poor sleep quality during the major public health emergencies， and poor sleep hygiene practice also contributes to poor sleep quality.

Objective: There is no effective therapy for patients with advanced medullary thyroid carcinoma (MTC). Vandetanib,a novel multitargeted receptor tyrosine kinase inhibitor, has previously shown antitumor activity in phase Ⅱ studies of patients with advanced MTC. This study was to evaluate the efficacy and the safety of vandetanib on advanced MTC. Methods: This study was an open, international multi-center phase Ⅲ clinical trial and the study number was NCT01298323. The single-center study was a sub-group analysis of the international study, which was conducted on 9 pathologically confirmed advanced MTC patients by Cancer Hospital Chinese Academy of Medical Sciences between March 2012 and October 2017. Vandetanib (300 mg) was orally administered daily till death or withdrawal. The efficacy was evaluated according to RECIST criteria and the adverse events were evaluated according to NCI criteria. Results: The objective response rate was 3/9,and the disease control rate was 4/9. The median progression-free survival was 44 months. All patients who had the elevated levels of calcitonin (CTN) and carcino-embryonic antigen (CEA) before treatment began to show the decreases in the level of CTN and CEA after 3 months and later showed again the increases in the levels of both tumor markers with tumor progression. By ROC curve analysis, CTN was of statistically significance(P<0.05, 95%CI 0.558-0.834), but CEA was not(P>0.05). Adverse events were generally mild (grade 1 or 2),including hypertension (9 cases),skin rash (9 cases), and diarrhea (6 cases). Two patients developed grade 3 elevation of serum glutamate pyruvate transaminase and one patient developed grade 3 elevation of drug-related bowel disease. No grade 4 drug-related adverse event occurred. Conclusions Vandetanib is effective and well tolerated for patients with locally advanced or metastatic MTC who have no chance for surgery. This indicates the increase of CTN is clinically relevant to disease progression, but the number of patients are extremely low, and, therefore further research is needed. Long-term use of vandetanib may cause resistance.