Objective To analyse the survival time and related factors of patients with brain stem glioma who received 3DCRT.Methods Thirty-six patients with brain stem tumor were admitted from October 2004 to December 2008 and all received 3D-CRT with the dosage (50-54 Gy,25-30 f,5-6 weeks).During treatment,the patients’ outcomes were analyzed by observing the changes of symptoms,signs and adverse radiotherapy reaction and all of them were followed-up in the next 3 years.The survival data were analyzed by Kaplan-Meire method.Results The median survival time was 9 months in the 23 pediatric patients and 15 months in 13 adult patients.One-,two-and three-year survival rates between pediatric group and the adult group were 43.5 ％ (10/13) vs 76.9 ％ (10/13),26.1％ (6/23) vs 46.2 ％ (6/13),8.7 ％ (2/23) vs 38.5 ％ (5/13).Karnofsky performance scale score at admission (x2 =20.059,P =0.000),tumor site (x2 =17.585,P =0.000),growth pattern (x2 =21.247,P =0.000) were associate with survival time.Conclusion 3DCRT is an effective therapy to brain stem glioma,childhood onset,pontine glioma,diffusion style and Karnofsky performance scale less than 80 are risk factors of poor prognosis.

Objective To study the diagnosis and treatment of Currarino triad Methods A retrospective study was made on clinical features, diagnosis; treatment and prognosis of 7 cases with Currarino triad Results In 6 patients definite diagnosis was made only intraoperatively including reoperation in 3 cases All the 7 cases were cured Postoperative urinary retention and infection developed in one each Conclusion Correct preoperative diagnosis of Currarino triad has great influence on the treatment Total excision of presacral mass should be emphasized

Objective:To investigate the effect of different postoperative nutritional support on the gastrointestinal function and nutritional status in acute colon peforation patients.Methods:60 cases of acute emergency operation patients with perforation of the colon,according to the given nutritional support treatment of the different ways,were divided into enteral parenteral joint nutrition (EN + PN) group and total parenteral nutrition (TPN) group.Clinical therapeutic effects of two groups were compared.Results:The results of EN + PN group were significantly better than the those in TPN group (P ＜ 0.05).Conclusion:EN + PN model can improve the postoperative nutritional status and accelerate the recovery of patients with acute colonic perforation.

Objective : To investigate the epidemiological and clinical characteristics of cases with pertussis in Yiwu City, Zhejiang Province, so as to provide insights into pertussis diagnosis and control. Methods: A total of 186 patients with definitive diagnosis of pertussis in medical institutions in Yiwu City from November 1, 2020 to August 31, 2022 were recruited, and subjects' demographic, clinical symptoms and history of pertussis vaccination were collected using questionnaire surveys. The temporal, population, and spatial distribution and clinical symptoms of pertussis were analyzed using a descriptive epidemiological method, and the clinical characteristics of pertussis patients with different doses of pertussis vaccination were compared. Results: Pertussis was found to predominantly occur during the period between July and November (101 cases, 54.30%), and the three highest-incidence regions included Jiangdong Street, Beiyuan Street and Choujiang Street (87 cases, 46.77%). The 186 pertussis cases included 105 males (56.45%) and 81 females (43.55%), and included 144 cases with age of onset under 7 year (77.42%). Preschool and diaspora children were predominant among all pertussis cases, and the main clinical symptoms included spasmodic cough (97 cases, 52.15%), post-tussive vomiting (82 cases, 44.09%) and aggravated cough at night (77 cases, 41.40%). Routine blood tests measured 119 cases with abnormal white blood cell counts (63.98%), 137 cases with abnormal lymphocyte counts (73.66%), 39 cases with abnormal neutrophil counts (20.97%), 21 cases with abnormal platelet counts (11.29%) and 111 cases with abnormal hemoglobin concentrations (59.68%). There were 55 cases that were unvaccinated (29.57%), 23 cases that were not fully vaccinated (12.37%), and 108 cases that were fully vaccinated (58.06%). There were significant differences among pertussis cases with different doses of vaccination in terms of age, incidence of post-tussive vomiting, percentage of abnormal platelet counts and percentage of hemoglobin concentrations (all P<0.05). Conclusions The majority of pertussis cases are preschool and diaspora children in Yiwu City from November 1, 2020 to August 31, 2022, and the clinical symptoms mainly include spasmodic cough, post-tussive vomiting and aggravated cough at night, with atypical symptoms. The capability for differential diagnosis of pertussis is required to be improved in medical institutions.

Objective:To explore the status quo of nurses' recognition of nursing adverse event reporting barrier and analyze its influencing factors.Methods:From September to October 2021, 2 347 nurses from 73 Class Ⅱ and Class Ⅲ medical institutions in Tianjin were selected as research subjects by convenience sampling. Questionnaire survey was conducted with the General Information Questionnaire, Adverse Event Reporting Barrier Scale and Patient Safety Culture Assessing Scale. Through univariate analysis, Spearman correlation analysis and multiple linear regression analysis, the factors influencing nurses' recognition of reporting barrier were explored.Results:A total of 2 347 questionnaires were collected and 2 335 valid ones were collected. Among 2 335 nurses, the total score of the Adverse Event Reporting Barrier Scale was 77.0 (69.0, 86.0), and the total score of safety culture attitude was 104.0 (99.0, 110.0). Spearman correlation analysis showed that there was a negative correlation between the total score of nurses' recognition of reporting barriers and the total score of safety culture attitude, and the difference was statistically significant ( r=-0.328, P<0.01). Multiple linear regression analysis showed that the motivation mechanism, reporting form of adverse events, job position, and safety culture attitude of nurses were the influencing factors of the recognition of reporting barriers, with a statistical difference ( P<0.05), which explained 13.1% of the variation. Conclusions:Motivation mechanism, reporting form of adverse events, job position, safety culture attitude of nurses are the influencing factors of recognition of reporting barriers. Nursing managers should take positive measures to create a non-punitive culture, optimize the adverse event reporting system, strengthen the training of adverse event reporting, and improve the recognition of nurses in reporting barriers, so as to increase the reporting rate of nursing adverse events.

Objective:To analyze the risk factors of acute kidney injury (AKI) in hip fracture patients with serious underlying diseases and establish a prediction nomogram.Methods:Clinical information of hip fracture patients admitted to the intensive care unit (ICU) of Beth Israel Deaconess Medical Center (BIDMC) was analyzed using the Medical Information Mart for Intensive Care (MIMIC)-IV. Patient comorbidities, disease scores, vital signs and laboratory tests, surgical modalities, invasive procedures, and drug use were recorded. According to the diagnostic criteria of AKI in the Kidney Disease Improving Global Outcome (KDIGO) guideline, the enrolled patients were randomly divided into training set and validation set. Based on logistic regression analysis, least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used to analyze the risk factors of AKI after admission, and the corresponding prediction model was calculated.Results:A total of 474 patients were enrolled, including 331 in the training set and 143 in the validation set. According to the diagnostic criteria of AKI of KDIGO guidelines, the patients were divided into AKI group (159 cases) and non-AKI group (172 cases). Univariate analysis showed that age ( t=2.61, P=0.009), coronary heart disease (χ 2=2.08, P=0.038), heart failure (χ 2=2.60, P=0.009), hemoglobin ( t=1.89, P=0.059), platelets ( t=1.81, P=0.070), urea nitrogen ( t=2.83, P=0.005), blood creatinine ( t=3.65, P<0.001), blood sodium ( t=2.55, P=0.011), blood glucose ( t=2.52, P=0.012), anion gap ( t=3.44, P=0.001), diastolic blood pressure ( t=2.72, P=0.007), mean arterial pressure ( t=2.16, P=0.031), SOFA score ( t=3.69, P<0.001), simplified acute physiological function score II (SAPSII) score ( t=2.95, P=0.003), as well as furosemide (χ 2=2.03, P=0.042), vancomycin (χ 2=1.70, P=0.089), vasoactive medications (χ 2=3.74, P<0.001) and use of invasive mechanical ventilation (χ 2=4.81, P<0.001) were risk factors associated with the development of AKI in hip fracture patients. Multivariate logistic regression analysis showed that age ( OR=1.03, P<0.001), coronary heart disease ( OR=2.05, P=0.069), hemoglobin ( OR=0.88, P=0.050), blood creatinine ( OR=1.37, P=0.009), blood sodium ( OR=1.07, P=0.026), anion gap ( OR=1.09, P=0.028) and vasoactive medications ( OR=3.83, P=0.018) and the use of invasive mechanical ventilation ( OR=6.56, P<0.001) were independent predictors of the development of AKI in hip fracture patients with serious underlying diseases. The area under the curve of the nomogram prediction model constructed by the above 8 predictors was 0.789, and the calibration curve of the nomogram was close to the ideal diagonal. Decision curve analysis showed that the net benefit of the model was significant. Conclusion:The incidence of AKI is high in hip fracture patients with serious underlying diseases. Age, coronary heart disease, hemoglobin, serum creatinine, serum sodium, anion gap, vasoactive drugs, and invasive mechanical ventilation can predict the occurrence of AKI to a certain extent. Combined with the risk factors, the construction of the corresponding prediction model can predict and manage the diagnosis and treatment of AKI in patients with hip fracture complicated with severe underlying diseases.

OBJECTIVETo evaluate the safety and efficacy of chimeric antigen receptors T cells (CAR-T) in childhood acute B lymphoblastic leukemia (B-ALL).

METHODSA relapsed B-ALL child after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was treated with CAR-T, and the related literatures were reviewed.

RESULTAn 11-year-old girl with TEL-AML1 fusion gene positive BALL who suffered a bone marrow relapse 28 months after remission from conventional chemotherapy. During the second remission, the patient received haploidentical allo-HSCT. She relapsed with detectable TEL-AML1 fusion gene even after chemotherapy and donor leukocyte infusions. She received an experimental donor-derived fourth generation CD19 CAR-T therapy. After infusion of 1 × 10(6)/kg CAR-T cells, she experienced only mild or moderate cytokine-release syndrome and the minimal residual disease turned negative. Then three maintenance of CAR-T cell infusions [(0.83-1.65)×10(6)/kg] was administered, and the disease-free survival had lasted for 10 months. However, the TEL-AML1 copies in her blood still increased and she died with leukemia relapse after additional CAR-T cell infusion.

CONCLUSIONTreatment of relapsed B-ALL with the fourth generation CAR-T cells directed against CD19 was effective and safe. CAR-T therapy is a novel therapeutic approach that could be useful for patients with relapsed and refractory B-ALL who have failed all other treatment options.

Bone Marrow ; Child ; Core Binding Factor Alpha 2 Subunit ; genetics ; Disease-Free Survival ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Neoplasm, Residual ; Oncogene Proteins, Fusion ; genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; therapy ; Receptors, Antigen, T-Cell ; genetics ; Recurrence ; Remission Induction ; T-Lymphocytes ; cytology ; Transplantation, Homologous

Objective: To analyze the correlation between skeletal vertical patterns and mandibular dental arch width, basal arch width and the dental buccolingual inclination of patients with skeletal ClassⅠ Methods: The CBCT data of 62 skeletal ClassⅠ malocclusion patients were collected and divided into a high-angle group with 19 cases, a mean-angle group with 22 cases, and a low-angle group with 21 cases according to the GoGn-SN angle. Mandible 3D reconstruction of the three groups was performed using Dolphin software, and dental arch widths, basal arch widths and buccolingual inclination of canines, first premolars and first molars, were measured and statistically analyzed respectively. Redults: Mandibular dental arch width showed no significant difference among the three groups (P>0.05). The basal arch widths of mandibular canines and first premolars in low-angle group were larger than those in the other groups (P<0.05). The buccolingual inclinations of mandibular canines and first premolars in high-angle group were larger than those in the other groups (P<0.05). The buccolingual inclination and basal arch width of the first molars among the three groups showed no significant differences (P>0.05). Pearson correlation tests showed that the basal arch widths of mandibular canines and first premolars were negatively correlated with GoGn-SN angle. Excluding the influence of dental arch width and basal arch width, there was still a significant positive correlation between the buccolingual inclination of mandibular canines and first premolars and the GoGn-SN angle (P<0.05). Conclusion The width of the basal bone arch between different skeletal vertical patterns mainly differs in the canine segment and the premolar segment, and the difference in the buccolingual inclination of the teeth is mainly to compensate for the difference in the GoGn-SN angle. In clinical practice, individualized therapy should be adopted according to the differences to achieve the long-term efficacy of correction.

OBJECTIVETo discuss the clinical features of Indium-related lung diseases.

METHODSWe searched database of Chinese and Pubmed, Embase, Web of Science to collect research data of indium-related lung diseases from Jan. 1998 to Aprl. 2014. Case reports, exposure histories and lab results were analysed and summarized.

RESULTS1998 to Mar 2010, ten cases of indium-related lung diseases were published. Seven cases of interstitial pneumonia were reported in Japan, two cases of pulmonary alveolar proteinosis (PAP) were reported in the USA and one case of PAP reported in China. Chest computer tomography (CT) showed diffuse or local ground glass appearance (GGA) in 8 cases, 3 of which also showed centrilobular nodules; Pulmonary function test were normal only in one out of 8 cases. Cholesterol clefts were found in 4 cases of interstitial pneumonia. 3 cases died among 6 cases who were followed-up.

CONCLUSIONSOccupational exposure to indium compounds are contributory to different pulmonary diseases, which are composed of interstitial pneumonia and pulmonary alveolar proteinosis. The relationships between In-C, In-S and these pulmonary diseases are unclear.

China ; Glass ; Humans ; Indium ; toxicity ; Japan ; Lung Diseases, Interstitial ; etiology ; pathology ; Occupational Exposure ; adverse effects ; Pulmonary Alveolar Proteinosis ; etiology ; pathology ; Respiratory Function Tests ; Tomography, X-Ray Computed