Objective To investigate the effect of cartoon video-assisted preoperative interview on the postoperative maladaptive behaviors of preschool pediatric patients.Methods One hundred preschool pediatric patients,aged 3-6 yr,weighing 12-28 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective strabismus surgery,were divided into 2 groups (n =50 each) using a random number table:cartoon video-assisted preoperative interview group (group Ⅰ) and routine preoperative interview group (group Ⅱ).In group Ⅰ,accompanied by the anesthesiologist,children and their parents watched the cartoon video designed for the perioperative process,and the anesthesiologist answered the questions that their parents had.After completion of tracheal intubation,dexmedetomidine 0.3 and 0.6 μg/kg were infused intravenously over 10 min in group Ⅰ and group Ⅱ,respectively.Three percent-4％ sevoflurane was inhaled to maintain anesthesia.The development and degree of agitation during stay in the post-anesthesia care unit (PACU) were recorded.The emergence time and length of PACU stay were also recorded.Postoperative maladaptive behaviors were assessed with the Post-Hospital Behavior Questionnaire at 1 week after surgery,and the occurrence of behavioral changes was recorded.Results Compared with group Ⅱ,the incidence of emergence agitation was significantly decreased,the degree of emergence agitation was reduced,the emergence time and length of PACU stay were shortened,and the incidence of behavioral changes (4％) was decreased after surgery in group Ⅰ (P＜0.05).Conclusion Cartoon video-assisted preoperative interview can effectively decrease the development of postoperative maladaptive behaviors of the preschool pediatric patients.

Objective To evaluate the efficacy of combination of multiple measures in preventing agitation during recovery from general anesthesia in the preschool children. Methods Four hundred and fifty preschool pediatric patients of both sexes, aged 3-6 yr, weighing 16-25 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective monocular strabismus surgery, were di-vided into 3 groups ( n=150 each) using a random number table method: routine prevention group ( groupⅠ) , midazolam-routine prevention group ( groupⅡ) and cartoon video-assisted admission to operating room-family members accompanying in postanesthesia care unit ( PACU)-routine prevention group ( groupⅢ) . Dexmedetomidine 0. 3μg∕kg was intravenously infused over 10 min in groupⅠ. On the basis of groupⅠ, midazolam 0. 05 mg∕kg was intravenously infused in the holding area in group Ⅱ, and children were admitted to the operating room while they were watching cartoons selected by themselves when accompanied by family members, and they were also accompanied by family members in PACU in group Ⅲ. The modi-fied Yale Preoperative Anxiety Scale score on admission to the operating room, Induction Compliance Checklist score, occurrence and degree of agitation during the recovery period, emergence time and dura-tion of PACU stay were recorded. Results Compared with groupⅠ, the modified Yale Preoperative Anxi-ety Scale score on admission to the operating room and Induction Compliance Checklist score were signifi-cantly decreased, and the incidence of agitation during the recovery period ( 25. 3％ in group Ⅰ, 12. 0％in group Ⅱ, 3. 3％ in group Ⅲ) was decreased in Ⅱ and Ⅲ groups , and the emergence time and dura-tion of PACU stay were significantly prolonged in groupⅡ( P<0. 05) . The incidence of agitation during the recovery period was significantly lower in group Ⅲ than in groupⅡ (P<0. 05). There was no significant difference in the constituent ratio of the degree of agitation among the three groups ( P>0. 05) . Conclusion Cartoon video-assisted admission to operating room-family members accompanying in PACU-routine pre-vention can effectively prevent the occurrence of agitation during recovery from general anesthesia in the pre-school children.

Objective:To investigate the clinicopathological features and misdiagnosis factors of ALK positive large B-cell lymphoma (ALK +LBCL). Methods:The clinicopathological data of 3 patients with ALK +LBCL in the Department of Pathology, the Affiliated Hospital of Xuzhou Medical University from 2010 to 2021 were collected retrospectively. Immunohistochemistry (IHC) was used for immunophenotyping, in-situ hybridization (ISH) for EBV-encoded RNA (EBER) detection, in-situ fluorescence hybridization (FISH, break-apart probes) for ALK, MYC, and CCND1 translocations. Next-generation sequencing (NGS) was used for the detection of gene fusions and mutations. And clinicopathological features and prognosis of patients were analyzed. Results:Among the 3 ALK +LBCL patients, there were 2 males and 1 female, aged 42, 59, and 39 years, respectively, none of which presented with B symptoms. Case 1 showed systemic lymphadenopathy with elevated serum EBV DNA loading, while cases 2 and 3 presented with extranodal lesions in the nasal and hard palate, respectively. Bone marrow biopsies were performed in cases 1 and 3, and neither showed involvement. Case 1 was at clinical stage Ⅲ while both cases 2 and 3 were at stage Ⅰ, and IPI score ranged 0-1 in all cases. The morphology of these cases was similar. The architecture was effaced by sheets of cohesive large cells growing in extensive infiltration and intra-sinus growth pattern. The neoplastic cells showed immunoblastic or plasmablastic morphology, and large anaplastic cells were easily found. The tumor cells expressed ALK protein cytoplasmically in almost all cells, with ALK gene translocations detected by FISH. Common B-cell and T-cell markers, including CD20, PAX5, CD19, CD2, CD3, CD5, CD7, CD43, CD56, and bcl-2, were negative, while plasmacytic differentiation markers, including CD138, CD38, and MUM1, were positive; CD22, BOB1 and OCT2 were variably expressed. CD10 was strongly expressed only in case 3. All cases were negative for bcl-6 but positive for CD4, perforin, CD30 (partial cells), pSTAT3 (diffusely), and MYC (40%-50%). The Ki-67 index was ranged 60%-70%. MYC translocation was not detected in any case by FISH. In case 1, EBER was strongly positive in>90% of tumor cells. Case 3 was diffusely positive for cyclin D1 but negative for SOX11 expression and CCND1 translocation. All cases harbored ALK fusion genes detected by NGS. In case 1, the fusion partner was TFG, which had not been reported in DLBCL, while in the other 2 cases, ALK fused with the CTCL gene, which was commonly seen in ALK +LBCL. Cases 1 and 3 were treated with ECHOP-based chemotherapy for six cycles and were followed up for 70 and 27 months, respectively, and both achieved complete remission. Conclusions:ALK +LBCL cases with diffuse EBER-positivity reported in this study show TGF as a new fusion partner of ALK in DLBCL, together with cyclin D1 expression. These rare cases are easily confused with EBV positive diffuse large B-cell lymphoma, not otherwise specified (EBV +DLBCL, NOS), cyclin D1 positive diffuse large B-cell lymphoma (cyclin D1 +DLBCL) and ALK positive anaplastic large cell lymphoma (ALK +ALCL), resulting in misdiagnosis. Being aware of these rare phenotypes is essential for pathologists to diagnose ALK+LBCL and guide appropriate treatment accurately.