Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To evaluate the methodological quality and measurement attribute quality of the evaluation tool for pediatric palliative care quality assessment tools,and to provide references for medical staff to select the best assessment tools.Methods The PubMed,Embase,Cochrane Library,Web of Science,CINAHL,Scopus,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,Chinese Biomedical Literature Database,GIN,NGC,NICE,NRAO,medlive,WHO,AAHPM,WHPCA,APHN were searched from inception to March 28,2024.Data were screened and extracted independently by 2 researchers.The consensus-based standards for the selection of health measurement instruments(COSMIN)checklist and quality criteria were employed to evaluate the methodological quality and psychometric properties of the included pediatric palliative care quality assessment tools.Finally,recommendations were formulated based on these evaluations.Results A total of 13 articles were included,involving 9 pediatric palliative care quality assessment tools.Among them,the PICU-QODD,PaPEQu and QCPCI demonstrated good content validity and internal consistency,and are recommended as Grade A.The remaining assessment tools are recommended as Grade B or C.Conclusion The PICU-QODD,PaPEQu and QCPCI are recommended for use,but further validation of their psychometric properties is still needed.

Objective To explore the clinical efficacy and medical costs of high ligation and stripping of the great saphenous vein,simple foam sclerotherapy,and high ligation of the great saphenous vein combined with foam sclerotherapy for treating varicose of great saphenous vein.Methods The clinical data of patients with varicose of great saphenous vein undergoing high ligation and stripping of the great saphenous vein,simple foam sclerotherapy,or high ligation of the great saphenous vein combined with foam sclerotherapy were analyzed retrospectively.The evaluation included efficacy assessment,quality of life evaluation,hospitalization days and costs,postoperative complications,and recurrence after surgery.Results There were no statistical differences in gender,age,disease course and clinical etiology anatomy pathophysiology(CEAP)grading system among the three groups(P＞0.05).The clinical efficacy assessments in all patients among the three groups showed significant effects at 3 and 6 months postoperatively.One patient in the group treated with high ligation of the great saphenous vein combined with foam sclerotherapy suffered deep vein thrombosis of lower extremity after operation.In terms of quality of life,there was no statistically significant difference in venous clinical severity score(VCSS)among the three groups at 3 months postoperatively(P＞0.05).The group treated with simple foam sclerotherapy showed significantly shorter hospitalization days compared with the other two groups.Additionally,the group treated with simple foam sclerotherapy showed lower hospitalization expenses,which was not statistically significant when compared to the group treated with high ligation and stripping of the great saphenous vein group(P＞0.05),but there was a statistical difference compared to the group treated with high ligation of the great saphenous vein combined with foam sclerotherapy(P＜0.05).Conclusion There are no significant differences in clinical efficacy,postoperative pain,and quality of life evaluation among the three methods.However,simple foam scle-rotherapy may reduce the length of hospitalization stay and direct medical costs.

Objective:To compare the differential regulatory effects of corticotropin releasing hormone(CRH)neu-rons in periaqueductal gray(PAG)and medial preoptic area(MPA)downstream of paraventricular nucleus(PVN)in mediating stress-related abnormal behaviors.Methods:The anterograde labeled virus AAV2/9-hSyn-DIO-hChR2-EYFP and AAV2/9-mCrh-SV40 NLS-Cre was injected into the PVN brain region of mouse,and the projection distribution of PVN axons in the PAG and MPA brain regions was observed after statistical analysis of its projection distribution through Image J.The optogenetic inhibitory virus mixture of AAV2/9-DIO-stGtACR2-EGFP and AAV2/9-mCrh-SV40 NLS-Cre targeting CRH neurons was injected into the PAG and MPA brain regions receiving the corresponding PVN projection,respectively,and the CRH neurons in the PAG and MPA brain regions were inhibited by optogenetic blue light 460 nm to observe the anxiety-related behaviors of mice under acute restraint stress.Results:Densely distributed CRHergic PVN axon terminals were observed in PAG and MPA brain regions.Optogenetic inhibition of CRH neurons in the PAG region of acute stress mice showed no significant change in social preference behavior.The eating latency decreased in the novelty-suppressed feeding test,and the escape latency increased under visual fear stimulation.Optogenetic inhibi-tion of CRH neurons in the MPA brain region showed no significant change in social preference,significantly decreased eating latency in the novelty-suppressed feeding test,and no significant change in escape latency under visual fear stim-ulation.Conclusion:CRH neurons in PAG and MPA brain regions downstream of PVN have differential regulation in a-cute stress-related anxiety behavior,but no difference in social behavior regulation,which provides theoretical support and basis for in-depth exploration of stress-related brain regions and cellular mechanisms.

Objective:To compare the differential regulatory effects of corticotropin releasing hormone(CRH)neu-rons in periaqueductal gray(PAG)and medial preoptic area(MPA)downstream of paraventricular nucleus(PVN)in mediating stress-related abnormal behaviors.Methods:The anterograde labeled virus AAV2/9-hSyn-DIO-hChR2-EYFP and AAV2/9-mCrh-SV40 NLS-Cre was injected into the PVN brain region of mouse,and the projection distribution of PVN axons in the PAG and MPA brain regions was observed after statistical analysis of its projection distribution through Image J.The optogenetic inhibitory virus mixture of AAV2/9-DIO-stGtACR2-EGFP and AAV2/9-mCrh-SV40 NLS-Cre targeting CRH neurons was injected into the PAG and MPA brain regions receiving the corresponding PVN projection,respectively,and the CRH neurons in the PAG and MPA brain regions were inhibited by optogenetic blue light 460 nm to observe the anxiety-related behaviors of mice under acute restraint stress.Results:Densely distributed CRHergic PVN axon terminals were observed in PAG and MPA brain regions.Optogenetic inhibition of CRH neurons in the PAG region of acute stress mice showed no significant change in social preference behavior.The eating latency decreased in the novelty-suppressed feeding test,and the escape latency increased under visual fear stimulation.Optogenetic inhibi-tion of CRH neurons in the MPA brain region showed no significant change in social preference,significantly decreased eating latency in the novelty-suppressed feeding test,and no significant change in escape latency under visual fear stim-ulation.Conclusion:CRH neurons in PAG and MPA brain regions downstream of PVN have differential regulation in a-cute stress-related anxiety behavior,but no difference in social behavior regulation,which provides theoretical support and basis for in-depth exploration of stress-related brain regions and cellular mechanisms.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To explore the clinical efficacy and medical costs of high ligation and stripping of the great saphenous vein,simple foam sclerotherapy,and high ligation of the great saphenous vein combined with foam sclerotherapy for treating varicose of great saphenous vein.Methods The clinical data of patients with varicose of great saphenous vein undergoing high ligation and stripping of the great saphenous vein,simple foam sclerotherapy,or high ligation of the great saphenous vein combined with foam sclerotherapy were analyzed retrospectively.The evaluation included efficacy assessment,quality of life evaluation,hospitalization days and costs,postoperative complications,and recurrence after surgery.Results There were no statistical differences in gender,age,disease course and clinical etiology anatomy pathophysiology(CEAP)grading system among the three groups(P＞0.05).The clinical efficacy assessments in all patients among the three groups showed significant effects at 3 and 6 months postoperatively.One patient in the group treated with high ligation of the great saphenous vein combined with foam sclerotherapy suffered deep vein thrombosis of lower extremity after operation.In terms of quality of life,there was no statistically significant difference in venous clinical severity score(VCSS)among the three groups at 3 months postoperatively(P＞0.05).The group treated with simple foam sclerotherapy showed significantly shorter hospitalization days compared with the other two groups.Additionally,the group treated with simple foam sclerotherapy showed lower hospitalization expenses,which was not statistically significant when compared to the group treated with high ligation and stripping of the great saphenous vein group(P＞0.05),but there was a statistical difference compared to the group treated with high ligation of the great saphenous vein combined with foam sclerotherapy(P＜0.05).Conclusion There are no significant differences in clinical efficacy,postoperative pain,and quality of life evaluation among the three methods.However,simple foam scle-rotherapy may reduce the length of hospitalization stay and direct medical costs.

Objective To evaluate the methodological quality and measurement attribute quality of the evaluation tool for pediatric palliative care quality assessment tools,and to provide references for medical staff to select the best assessment tools.Methods The PubMed,Embase,Cochrane Library,Web of Science,CINAHL,Scopus,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,Chinese Biomedical Literature Database,GIN,NGC,NICE,NRAO,medlive,WHO,AAHPM,WHPCA,APHN were searched from inception to March 28,2024.Data were screened and extracted independently by 2 researchers.The consensus-based standards for the selection of health measurement instruments(COSMIN)checklist and quality criteria were employed to evaluate the methodological quality and psychometric properties of the included pediatric palliative care quality assessment tools.Finally,recommendations were formulated based on these evaluations.Results A total of 13 articles were included,involving 9 pediatric palliative care quality assessment tools.Among them,the PICU-QODD,PaPEQu and QCPCI demonstrated good content validity and internal consistency,and are recommended as Grade A.The remaining assessment tools are recommended as Grade B or C.Conclusion The PICU-QODD,PaPEQu and QCPCI are recommended for use,but further validation of their psychometric properties is still needed.

Objective:To analyze and summarize the efficacy and safety of thalidomide in the treatment of refractory systemic juvenile idiopathic arthritis（sJIA）.Methods:The clinical data of ten patients with refractory sJIA admitted to Department of Nephrology and Immunology in Children's Hospital of Hebei Province from January 2015 to March 2022 were collected，and the clinical manifestations，efficacy and safety of thalidomide in the treatment of refractory sJIA were analyzed retrospectively. Systemic juvenile arthritis disease activity score（sJADAS）was used to evaluate the efficacy of the treatment. Statistical analysis was performed by repeated measurements using general linear models.Results:Among the 10 children（4 males and 6 females）with refractory sJIA，the average age of onset was（7.5±3.3）years. Seven patients were complicated with macrophage activation syndrome at an early stage of disease.The average course of disease was（4.4±1.7）years，and the longest course of disease was 8.3 years. Before the application of thalidomide，all the 10 children experienced relapses（ranging from 2 to 10 times）. The indices of 10 children treated with thalidomide at 6 months and 12 months were compared with those before treatment. Peripheral blood leukocytes［（10.19±3.67）×10 9/L，（8.53±2.83）×10 9/L vs.（16.11±7.81）×10 9/L， F=7.918，11.084， P=0.020，0.009］，C-reactive protein［19.13（0.38，35.21）mg/L，8.05（0.10，18.00）mg/L vs. 59.34（24.20，131.90）mg/L， F=7.030，12.731， P=0.026，0.006］，sJADAS scores［6.00（1.50，12.50）scores，3.00（0，12.50）scores vs. 20.00（11.50，28.00）scores， F=14.710，17.870， P=0.004，0.002］were decreased significantly. The doses of prednisone［0.13（0，0.45）mg/（kg·d），0.02（0，0.06）mg/（kg·d）vs. 0.42（0.16，1.47）mg/（kg·d）， F=5.890，7.623， P=0.041，0.022］were significantly decreased.All the differences were statistically significant. Prednisone was successfully discontinued in 7 cases. Tocilizumab was gradually withdrawn in 3 cases，and tocilizumab administration interval was prolonged in 1 case. None of the 10 children had serious adverse reactions. Conclusion:Thalidomide is clinically effective in the treatment of sJIA，and can reduce the required dose of prednisone and prolong the tocilizumab free remission.

Objective:To compare the similarities and differences of macrophage activation syndrome（MAS）combined with systemic juvenile idiopathic arthritis（sJIA）versus with juvenile onset systemic lupus erythematosus（JSLE）.Methods:The clinical data of 48 children with MAS admitted to the Department of Nephrology and Immunology in Children's Hospital of Hebei Province from May 2015 to January 2023 were retrospectively analyzed. The patients were divided into sJIA-MAS and JSLE-MAS group，and the clinical manifestations，laboratory indicators and treatment of the two groups were compared.Results:Among the 48 children（14 males and 34 females）with MAS，the average age of onset was 9.5（3.0，11.8）years. There were 28 cases（11males and 17 females）of sJIA-MAS and 20 cases（3 males and 17 females）of JSLE- MAS. All the 48 children with MAS had fever and hyperferinemia，and the fever with sJIA-MAS was mostly continued fever or remittent fever. Respiratory tract infection was the most common trigger in sJIA-MAS［15 cases（53.6%）］，and disease activity was the most common trigger in JSLE-MAS［13 cases（65.0%）］.Additionally，viral infections（EB virus and cytomegalovirus）were also one of the triggers in MAS［sJIA：7 cases（25%），JSLE：4 cases（20%）］.Compared with JSLE-MAS，the number of days with fever［15.0（12.0，21.0）days vs. 6.0（4.0，9.5）days， Z=-3.812， P=0.001］and the length of hospital stay［29.0（26.3，39.8）days vs.26.0（19.3，30.8）days， Z=-1.958， P=0.049］were longer in sJIA. Compared with JSLE-MAS，ALT［（685.32±561.67）U/L vs.（139.61±124.44）U/L， t=4.973， P=0.001］，AST［784.00（235.25，1 251.25）U/L vs.189.50（53.25，374.08）U/L， Z=-3.283， P=0.001］，CRP［11.48（3.56，28.89）mg/L vs.1.91（0.53，8.98）mg/L， Z=-3.200， P=0.001］，ferritin［32 167.0（12 384.8，65 963.8）μg/L vs.2 003.5（922.5，11 430.0）μg/L， Z=-4.130， P=0.001］，ferritin max/ESR min［1 353.35（355.75，4 342.53）vs.91.92（34.94，291.53）， Z=-4.120， P=0.001］were higher in sJIA.The decrease of CRP was greater in sJIA［80.04（45.64，143.71）mg/L vs.10.20（6.27，25.64）mg/L， Z=-4.433， P=0.001］.Compared with sJIA-MAS，peripheral white blood cell counting［4.05（2.90，7.73）×10 9/L vs.1.56（1.15，3.47）×10 9/L， Z=-3.577， P=0.001］and platelet counting［（162.68±92.19）×10 9/L vs.（110.10±72.99）×10 9/L， t=2.118， P=0.040］were lower in JSLE-MAS. Kidney involvement was more common in JSLE-MAS［10 cases（50%）vs.0 cases（0%）， χ 2=17.684， P=0.001］.There was no significant difference in the incidence of sJIA-MAS and JSLE-MAS meeting the criteria of hemophagocytic lymphohistiocytosis［6 cases（21.4%）vs.5 cases（25.0%）， χ 2=0.084， P=0.772］. Conclusion:Compared with JSLE-MAS，sJIA-MAS is more dangerous and difficult to control，while JSLE-MAS involves more organs，among which the blood system and kidney are more common.