Objective To explore the association of IL-10-592A/C polymorphism with the susceptibility to respiratory syncytial virus(RSV) bronchiolitis and disease severity,and to explore the impact of IL10-592A/C polymorphism upon total serum IL-10 levels in children with RSV bronchiolitis. Methods One hundred children (patients group) admitted to hospital with RSV bronchiolitis and 100 healthy children (control group) were recruited. PCR restriction length fragment polymorphism assay was used to detect the single nucleotide polymorphisms of IL-10-592A/C. Total serum IL-10 levels in patients group were assayed with ELISA. Results The genotype frequency of IL-10-592A/C were AA 44% ,AC 38% ,CC 18% in patients group ,and AA 41% ,AC 42% ,CC 17% in the control group,it showed no significant difference between two groups (χ2= 0. 33, P > 0. 05) . The frequency of each allele were A 63%, C 37 % in patient group, and A 64% ,C 36% in the control group,there was no significant difference in allele frequency between two groups (χ2=0. 43 ,P >0. 05) . There was no significant difference in total serum IL-10 levels between different genotype of IL-10-592A/C (F = 0. 87, P > 0. 05) . The differences in genotype frequency of IL-10-592A/C were not significant between mild and moderate to severe cases (χ2= 2. 67, P > 0. 05) . Conclusion IL-10-592A/C gene polymorphisms do not correlated with RSV bronchiolitis.

α-thalassemia is a type of microcytic hypochromic anemia caused by variants of alpha-globin gene, and is one of the most common monogenic disorders in southern China. The population screening model based on hematologic phenotype has achieved great results in areas with high incidence of thalassemia. However, with the continuous decline of the cost of genetic testing and implementation of screening programs for thalassemia gene carriers, more variants in the alpha-globin gene have been discovered, which also brings great challenges to clinical genetic counseling. From the perspective of alpha-globin genetic analysis, this consensus has discussed the contents of pre- and post-test genetic counseling, with an aim to provide standardized guidance for clinicians.

Objective To apply Six-minute Walk Test (6MWT) in acute stroke patients and analyze the results. Methods From Novem-ber, 2014 to January, 2015, 29 acute stroke patients with multiple or single infarction accepted 6MWT. The distance, distance per minute, blood pressure and heart rate before and after test, adverse events or discomforts during the test were recorded. Weak and fatigue scores were calculated. Results The mean of distance in acute stroke patients was (240.1±17.2) m, that was (46.8±3.3)%of the predicted values in the healthy. Male patients walked (255.4±21.40) m, not different from (214.9±28.4) m in female (t=-1.151, P=0.26). The distance liked to be negatively correlated with age (r=-0.356, P=0.058). The distance was similar in each minute. Weak score was (46.8±3.3)%, fatigue score was mostly between-20 and 20, and no correlation was found between them. Blood pressure and heart rate increased significantly at the end of the test (t>2.476, P<0.05). Few of patients complained mild discomforts. Conclusion 6MWT is safe and suitable for acute stroke patients for physical mobility judgement, but adverse events need to be cared.

Objective To identify risk factors for local recurrence and distant metastasis in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Methods We retrospectively reviewed 269 patients with UTUC who had performed RNU from 2003 to 2013 in the Affiliated Hospital of Qingdao University.158 were males and 111 were females,aged range from 37 to 86 years old,left side were 144 cases and right side were 125 cases,157 cases occurred in renal pelvis and 112 cases in ureter,the diameter of tumor ＞ 3 cm were 163 cases,≥ pT3 stage were 143 cases,presence of lymphovascular invasion (LVI) were 35 cases,high grade tumors (G3) were 185 cases,presence of hydronephrosis were 185 cases,multifocal tumors were 28 cases,sessile tumors were 86 cases,neutrophil to lymphocyte ratio(NLR) ≥ 2.0 were 109 cases,estimated glomerular filtration rate (eGFR) ＜ 60ml/(min · 1.73 m2) were 62 cases,plasma fibrinogen ≥3.2 g/L were 129 cases.Univariate and multivariate analyses were performed to identify independent prognostic factors for local recurrence-free survival (IRFS) and distant metastasis-free survival (dMFS).Results The median follow-up was 43.8 months (range 4.4-131.8).30 patients had a local recurrence with a median intermittent period of 19.4 months (range 4.3-71.3).35 patients had a distant metastasis with a median intermittent period of 17.7 months (range 4.1-51.4).In univariate analysis,sessile tumor(P =0.041),tumor multifocality (P =0.027),location in ureter (P =0.001),presence of LVI (P＜0.001),≥pT3 stage(P ＜0.001),eGFR ＜60ml/(min · 1.73 m2) (P =0.009) and plasma fibrinogen ≥ 3.2 g/L (P ＜ 0.001) were associated with lRFS.While high-grade tumor (G3) (P =0.012),sessile tumor (P ＜ 0.001),presence of LVI (P ＜ 0.001),presence of hydronephrosis (P =0.046),and NLR ≥2.0 (P =0.002) were associated with dMFS.Multivariate analysis revealed that location in ureter(HR =4.835,95 ％ CI 1.792-13.044,P =0.002),presence of LVI (HR =5.037,95 ％ CI 2.183-11.230,P ＜ 0.001),≥pT3 stage(HR =2.987,95％ CI 1.078-8.283,P =0.035) and plasma fibrinogen ≥3.20g/L (HR =4.281,95 ％ CI 1.454-12.603,P =0.008) were independent factors for lRFS.Sessile tumor (HR =6.097,95％ CI 2.536-14.660,P ＜ 0.001),presence of LVI (HR =4.191,95％ CI 2.035-8.633,P ＜ 0.001),and NLR ≥2.0 (HR =2.741,95％ CI 1.128-6.657,P =0.026) were independent factors for dMFS.We stratified patients into three risk groups of LR and DM based on the results of the multivariate analysis respectively.The 1-year,3-year,5-year lRFS rates were 99.0％,96.8％,95.0％ in the low-risk group;94.5％,91.2％,87.6％ in the intermediate-risk group;and 77.8％,58.8％,58.8％ in the high-risk group.The differences among groups were significant (P ＜ 0.001).The 1-year,3-year,5-year dMFS rates were 98.4％,97.6％,96.0％ in the low-risk group,88.0％,73.8％,71.8％ in the intermediate-risk group,and 63.7％,42.9％,28.5％ in the high-risk group.The differences among groups were significant as well(P ＜ 0.001).Conclusion Location in ureter,presence of LVI,≥ pT3 stageand plasma fibrinogen ≥3.2 g/L were independent factors for lRFS.Sessile tumor,presence of LVI,and NLR ≥ 2.0 were independent factors for dMFS.The risk stratification models may be useful for identifying the patients with high risk of LR/DM after surgery.

Objective:To explore the effects of family-centered conductive education on the muscle strength in children with cerebral palsy and the stress of caregivers.Methods:Totally 92 children with cerebral palsy and 92 their main caregivers admitted into the Affiliated Hospital of Jining Medical University from October 2018 to December 2019 were selected and divided into a control group and a conductive education group according to the random number table, with 46 children with cerebral palsy and their 46 main caregivers in each group. Patients in the control group received routine care, while patients in the conductive education group underwent family-centered conductive education on the basis of routine care. The Chinese version of the Modified Ashworth Scale (MAS) , Caregiver Strain Index (CSI) , and the Chinese version of Family Management Measure (FaMM) were used to evaluate the muscle strength, caregiver pressure, and disease management ability of the two groups before and after intervention. Therefore, there were actually 43 cases in the control group and 42 cases in the conductive education group.Results:After intervention, the MAS scores of the two groups were lower than those at admission, and the score was lower in the conductive education group than in the control group, with statistically significant differences ( P<0.05) ; the CSI score of caregivers in the conductive education group was lower than that in the control group, and the difference was statistically significant ( P< 0.05) , while the FaMM score was higher than that in the control group, with statistically significant difference ( P<0.05) . Conclusions:Family-centered conductive education can effectively reduce the muscle strength of children with cerebral palsy, alleviate the pressure of their caregivers, and improve the caregivers' disease management ability.

OBJECTIVETo compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer.

METHODSForty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated.

RESULTSOverall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively).

CONCLUSIONMR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.

OBJECTIVETo explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer.

METHODSBetween December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis.

RESULTSA total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52).

CONCLUSIONSMR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.

Objective:To investigate the changes and clinical significance of serum matrix metalloproteinase-9 (MMP-9), squamous cell carcinoma antigen (SCC), cytokeratin 19 fragment (CYFRA21-1), carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) in peripheral lung cancer.Methods:Sixty-eight patients with peripheral lung cancer who received treatment in Luqiao Hospital of Taizhou Enze Medical Center (Group) between January 2017 and January 2020 were included in the observation group. Sixty-five patients with benign lung diseases who concurrently received treatment in the same hospital were included in the observation group 1, and another 65 healthy participants who concurrently received physical examination were included in the control group. Serum levels of MMP-9, CYFRA21-1, SCC, NSE and CEA were compared among the three groups. The sensitivity and specificity of using these indicators alone and in combination in the diagnosis of peripheral lung cancer were compared.Results:Serum levels of MMP-9, CYFRA21-1, SCC, NSE and CEA in the observation group (14.98 ± 2.10) ng/mL, (17.13 ± 2.71) ng/mL, (1.98 ± 0.41) μg/mL, (24.13 ± 2.10) ng/mL and (17.10 ± 2.10) ng/mL, respectively, which were significantly higher than those in the observation group 1 [(9.12 ± 1.41) ng/mL, (10.12 ± 1.58) ng/mL, (1.37 ± 0.31) μg/mL, (16.31 ± 1.78) ng/mL, (12.13 ± 1.79) ng/mL] and control group [(5.10 1 ± 0.68) ng/mL, (6.02 ± 0.94) ng/mL, (0.71 ± 0.11) μg/mL, (11.10 ± 1.02) ng/mL, (8.13 ± 1.02) ng/mL] ( F1 = 932.781, F2 = 737.100, F3 = 368.591, F4 = 989.851, F5 = 462.291, all P < 0.05). Serum levels of MMP-9, CYFRA21-1, SCC, NSE and CEA in patients with stage I-II peripheral lung cancer were (11.12 ± 2.10) ng/mL, (9.12 ± 1.85) ng/mL, (1.52 ± 0.21) μg/mL, (18.12 ± 3.02) ng/mL, (7.52 ± 1.02) ng/mL, respectively, which were significantly lower than those in patients with stage III-IV peripheral lung cancer [(15. 89 ± 2.18) ng/mL, (21.56 ± 2.11) ng/mL, (2.04 ± 0.31) μg/mL, (28.15 ± 2.62) ng/mL, (15.12 ± 1.55) ng/mL, t1 = 9.013, t2 = 25.146, t3 = 7.714, t4 = 14.586, t5 = 22.705, all P < 0.05]. The sensitivity (83.33%) and specificity (86.67%) of combined detection of all indicators were significantly higher than those of single detection of MMP-9 (50.00%, 59.68%), CEA (50.00%, 61.29%), CYFRA21-1 (66.67%, 58.06%), SCC (50.00%, 54.84%) or NSE (66.67%, 58.06%) (all P < 0.05). Conclusion:Serum levels of MMP-9, CYFRA21-1, SCC, NSE and CEA in patients with peripheral lung cancer are significantly increased, which has an important value in the diagnosis of peripheral lung cancer. The combined detection of the above indicators can increase the diagnostic accuracy of peripheral lung cancer in the clinic.

Objective:To explore the characteristics of SLCO1B1/ SLCO1B3 gene variants among children with Rotor syndrome (RS). Methods:Four children who were admitted to the Department of Hepatology of Hunan Children′s Hospital between January 2019 and January 2022 were selected as the study subjects. Trio-whole exome sequencing was carried out for the four families, and gel electrophoresis was used to verify an insertional variant of long-interspersed element-1 (LINE-1).Results:Genetic testing has identified three variants of the SLCO1B1 gene, including c. 1738C>T (p.R580*), c. 757C>T (p.R253*) and c. 1622A>C (p.Q541P), and two variants of the SLCO1B3 gene, including c. 481+ 22insLINE-1 and c. 1747+ 1G>A among the children. Three of them were found to harbor homozygous variants of the SLCO1B1/ SLCO1B3 genes, and one has harbored compound heterozygous variants. Sanger sequencing confirmed the existence of all variants, and gel electrophoresis has confirmed the existence of the LINE-1 insertional variant of about 6 kb within intron 6 of the SLCO1B3 gene in all children. Conclusion:The pathogenesis of the RS among the four children may be attributed to the variants of the SLCO1B1/ SLCO1B3 genes. The LINE-1 insertion variant of the SLCO1B3 gene may be common among Chinese RS patients.

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.