Abstract: Objective　To investigate the treatment outcomes of patients with pulmonary tuberculosis (PTB) in Xinjiang Production and Construction Corps and to explore the risk factors affecting these outcomes, so as to provide a scientific basis for the prevention and treatment of pulmonary tuberculosis in the corps region. Methods　TB patients registered in the Corps from 2016 to 2022 were selected, and the basic demographic and clinical data of the research objects were collected by retrospective method. Log-rank test was used for univariate analysis and the Cox multivariate regression model was used to analyze the influencing factors of treatment outcomes of patients with pulmonary tuberculosis. Results　From 2016 to 2022, a total of 8 838 TB patients were registered in the TB Management Information System of Xinjiang Production and Construction Corps, of which 495 cases were untreated, 43 cases had changed diagnoses, 301 cases had no treatment outcomes, 6 cases were diagnosed as extrapulmonary tuberculosis, 11 cases were diagnosed as tracheobronchial tuberculosis, and finally 7 982 TB patients were included in the study. Of the 7 982 patients, 7 578 (94.94%) were treated successfully, while 404 (5.06%) had adverse outcomes (including 32 cases of failure, 13 cases of TB death, 173 cases of non-TB death, 12 cases lost to follow-up, 94 cases of adverse reactions, 10 cases transferred to multi-drug resistance treatment, and 70 other cases). Multivariate Cox regression analysis showed that the >30 to 60-year-old and >60-year-old age groups (OR=1.565, P=0.009; OR=2.960, P<0.001), belonging to ethnic minorities (OR=1.526, P<0.001), being a patients with diabetes mellitus (OR=1.696, P=0.002), current address being in other areas of the province or patients from other provinces (OR=1.419, P=0.004; OR=1.624, P=0.001), receiving retreatment (OR=1.910, P<0.001), and absence of primary care management (OR=1.351, P=0.003) were the risk factors for unsuccessful treatment outcomes in the corps' pulmonary tuberculosis patients. Conclusions　The treatment success rate of pulmonary tuberculosis patients in the Corps region is relatively high, but there is still a need to strengthen the treatment and management of the elderly, ethnic minorities, diabetes patients, non-local floating population, retreatment patients and patients who did not receive primary management.

Objective:To evaluate the efficacy and safety of CD30 antibody-drug conjugates (ADC) brentuximab vedotin (BV) combined with chemotherapy in children with refractory or relapsed classic Hodgkin′s lymphoma (R/R cHL).Methods:Clinical data (including age, gender, B symptoms, clinical stage, previous treatment, etc.) of the 10 R/R cHL children diagnosed and treated at Beijing Children′s Hospital Affiliated to Capital Medical University from October 2021 to August 2023 were analyzed retrospectively. According to the different intensity of chemotherapy drugs, the dose of BV applied in the same course of treatment was 1.8 mg/kg for BV applied once every 3 weeks, and 1.2 mg/kg for BV applied once every 2 weeks. All 10 patients received at least 2 cycles of BV combined with chemotherapy and were evaluated every 2 cycles. The patients were followed up until May 31, 2024. The infusion reactions and adverse reactions after treatment were recorded.Results:In all 10 patients, there were 7 males and 3 females, the age ranged from 5.3-16.9 years, and there were 6 cases of refractory and 4 cases of relapsed. There were 6 cases of nodular sclerosis type, 2 cases of mixed cell type, 1 case of lymphocyte-rich type, and 1 case of lymphodepletion type. There were 5 cases of stage Ⅳ and 5 cases of stage Ⅲ. Previous treatment was mainly chemotherapy, 4 cases received radiotherapy and 1 case received programmed cell death protein 1 (PD-1) antibody therapy. The follow-up time ranged from 9 to 27 months. A total of 43 courses with 49 doses of BV alone or combined with chemotherapy were recorded, and the number of courses was 2 to 10 times. All 10 children responded to the treatment, and 9 achieved complete remission. BV infusion was successfully completed in all cases. A total of 28 cases of grade 3 or above adverse events were recorded, mainly myelosuppression, all of which were related to chemotherapy and did not affect sequential treatment.Conclusion:Brentuximab vedotin has demonstrated efficacy and a tolerable safety profile in the treatment of refractory and relapsed CD30-positive Hodgkin′s lymphoma in children.

Objective:To evaluate the efficacy and safety of brentuximab vedotin (BV) combined with rituximab and attenuated chemotherapy in the treatment of children with classic Hodgkin lymphoma (cHL).Methods:A prospective, non-randomized, risk-assigned study. Clinical data (including age, gender, B symptoms, bulky disease, CD30 and Epstein-Barr virus-encoded RNA(EBER) expression, clinical stage, risk stratification, etc.) of 28 intermediate to high-risk cHL children diagnosed and treated at Beijing Children′s Hospital Affiliated to Capital Medical University from October 2022 to May 2024 were collected. Immuno-targeted combined with attenuated chemotherapy was administered based on risk stratification and early treatment response. The patients were followed up until May 1st, 2024. The infusion reactions and adverse reactions after treatment were recorded.Results:In all 28 patients, there were 22 males and 6 females, the age was 12 (5,16) years, 16 cases (57%) presented with bulky disease and 10 cases (36%) with B symptoms. The most common pathological type was nodular sclerosis (14 cases, 50%). There were 7 cases of stage Ⅱ, 14 cases of stage Ⅲ and 7 cases of stage Ⅳ according to the Ann Arbor staging system. There were 5 cases in the intermediate-risk group and 23 cases in the high-risk group. EBER was positive in 20 cases (71%) and negative in 6 cases (21%), and CD30 antigen was expressed in tumor cells of all enrolled children. Treatment duration: 5 cases (18%) received 4 courses of treatment, 21 cases (75%) received 6 courses of treatment, and 2 cases (7%) received 8 courses of treatment, 25 cases (89%) achieved complete metabolism response (CMR) through early assessment after 2 courses of chemotherapy. The CMR rates were 100% in intermediate-risk group and 87% (20/23) in high-risk group, respectively. Four patients (14%) finally received residual field radiotherapy. Toxicities included grade Ⅰ-Ⅱ myelosuppression, early infusion reaction and mild peripheral neuropathy, only one case of grade 3 adverse events was recorded and did not affect sequential treatment. At the end of treatment and 3 months of follow-up, the levels of IgA, IgG and IgM were all decreased compared with the baseline before chemotherapy, and the total B cell count began to be lower than the level before chemotherapy at the early stage of treatment (after 2 courses). The total B cell count monitored during treatment was 50 (0, 101)×10 6/L and was 12 (0, 25)×10 6/L at the end of treatment. The follow-up time was 6 (3, 13) months, all 28 children had event-free survival and all achieved complete remission. At 6 and 9 months of follow-up, IgA, IgG, IgM and total B cell counts returned to pre-chemotherapy baseline levels, respectively. Conclusion:BV combined with rituximab attenuated chemotherapy has demonstrated efficacy and a tolerable safety profile in the treatment of cHL in children, and significantly reduce radiation rate.

BackgroundThe guardianship ability of guardians of patients with severe mental disorders plays an important role in supporting the patients' recovery and reintegration into society. It is necessary to develop a scientific tool since there is a lack of tools to quantitatively assess the guardianship ability. ObjectiveTo explore and develop an assessment scale for the guardianship ability of guardians of patients with severe mental disorders， so as to provide references for the construction of scientific and reasonable guardianship ability evaluation tools. MethodsA pool of scale items was constructed through a literature review and interviews， followed by two rounds of expert consultation with 15 specialists. 364 guardians of patients with severe mental disorders in Guangzhou were investigated. The scale items were screened and optimized using item analysis and exploratory factor analysis， and the structural validity of the scale was further verified through confirmatory factor analysis. The content validity of the scale was evaluated by item-level content validity index （I-CVI） the average scale-level content validity index （S-CVI/Ave）. The reliability of the scale was tested by Cronbach's α coefficient and split-half reliability. ResultsThe guardianship ability scale for guardians of patients with severe mental disorders consists of 25 items， including three dimensions of guardianship willingness， guardianship knowledge and behavior and guardianship self-efficacy. The results of the item analysis showed that all items met the corresponding criteria and were retained. Validity test： the I-CVI ranged from 0.800 to 1.000， and the S-CVI/Ave was 0.964. Factor load of each item on the corresponding factors ranged from 0.596 to 0.976， and the model demonstrated good fit： chi-square degree of freedom ratio （χ²/df） was 2.444， Tucker-Lewis index （TLI） was 0.908， comparative goodness of fit index （CFI） was 0.917， standardized root mean square residual （SRMR） was 0.049， and root mean square residual （RMSEA） was 0.089. Reliability test showed that the total scale had a Cronbach's α coefficient of 0.966， and the split half reliability coefficient was 0.915. ConclusionThe guardianship ability scale for patients with severe mental disorders developed in this study has good reliability and validity， and has certain application value for the assessment of guardianship ability for patients with severe mental disorders. ［Funded by Health Science and Technology Project of Guangzhou （number， 20221A011049）］

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

ObjectiveTo explore the therapeutic effect and mechanism of Yiqi Huoxue Tongbian prescription on slow transit constipation （STC） in rats. MethodThe rat model of STC was established by gavage of loperamide hydrochloride. Rats were assigned into control， model， mosapride， low-， medium-， and high-dose （3.51， 7.02， and 14.04 g·kg^-1， respectively） Yiqi Huoxue Tongbian prescription groups. The changes of general signs， fecal moisture content， and intestinal propulsion rate were measured after model establishment and drug administration. The colonic mucosal changes were observed by hematoxylin eosin staining. Enzyme-linked immunosorbent assay was employed to determine the content of substance P （SP） and vasoactive intestinal peptide （VIP） in the colon of rats in each group. The gray values of aquaporin （AQP） 3， AQP4， AQP8， and c-Kit in rat colon tissue were measured by immunohistochemistry and Western blot， and the changes of intestinal flora were detected by 16S rRNA high-throughput sequencing. ResultCompared with the model group， 10 days of treatment with Yiqi Huoxue Tongbian prescription increased the fecal moisture content and intestinal propulsion rate （P<0.01）. The medium- and high-dose Yiqi Huoxue Tongbian prescription groups and the mosapride group showed no obvious mucosal inflammation and neat arrangement of goblet cells with a large number in the colon tissue. Moreover， the three groups showed increased SP content （P<0.01） and decreased VIP content （P<0.01） in the serum. The medium- and high-dose Yiqi Huoxue Tongbian prescription groups showed down-regulated protein levels of AQP3， AQP4， and AQP8 （P<0.01） and up-regulated protein level of c-Kit （P<0.01）. The drug administration groups presented slightly increased observed species， Chao1， ACE， and Shannon， Simpson， and PD whole tree. The principal component analysis showed that the control group had a short distance with the high- and medium-dose Yiqi Huoxue Tongbian prescription groups， indicating that high- and medium-dose Yiqi Huoxue Tongbian prescription can recover the intestinal flora to that in the control group. ConclusionYiqi Huoxue Tongbian prescription can alleviate the defecation status of rats with slow transit constipation by down-regulating the expression of AQP3， AQP4， and AQP8 to reduce the absorption of water in the intestine， up-regulating the expression of c-Kit to increase the number and distribution of Cajal interstitial cells， and regulating the balance of flora in the colon tissue.

In order to further strengthen the training and management of clinical teachers, broaden the career development channels of clinical teachers, and truly stimulate their teaching enthusiasm and initiative, this study further classifies clinical teachers according to the principle of the Snell model, focuses on the training of educational clinicians, and explores the training mechanism of teaching talents in line with the actual development needs of hospitals affiliated to universities from the aspects of selection, training, incentive, and assessment. The results of practice show that related practices have a good effect, and the mean number of teaching achievements was 1.98 for the 56 educational physicians, which was 3.9 times that for non-educational physicians. The per capita teaching achievements of educational physicians tended to increase every year compared with those of non-educational physicians. The training path for educational physicians provides useful experience for the construction of clinical teaching team and the high-quality development of education and teaching, and at the same time, it is necessary to further strengthen the dynamic adjustment of talent echelon, the improvement of operating mechanism, and the introduction of new technology.

Objective:To investigate the clinical significance of CX3CL1 in pSS-ILD.Methods:A total of 103 pSS patients treated in the Department of Rheumatology and Immunology of the Affiliated Hospital of Guilin Medical College from December 2019 to December 2020 were included (42 cases with ILD and 61 cases without ILD), and 46 healthy physical check-up subjects in the health check-up center of the Affiliated Hospital of Guilin Medical college were included as controls. Demographic data, clinical manifestations, clinical parameters, lung function test, lung HRCT and serum samples of enrolled patients were collected. The serum levels of CX3CL1 and KL-6 in PSS-ILD patients, pSS patients and healthy subjects were detected by ELISA, and the correlation between CX3CL1 and clinical related indexes in pSS-ILD and pSS patients was analyzed. Independent sample t test, Kruskal-Wallis H test, Pearson correlation and Logistic regression analysis were used for statistical analysis. Results:As KL-6, the levels of CX3CL1 were significantly higher in the pSS-ILD group compared to both the pSS and control groups [CX3CL1: 9.08 (3.97, 30.56)ng/ml, 8.12 (6.16, 8.89)ng/ml, and 7.09 (5.86, 9.07)ng/ml, H=3.53, P=0.019; KL-6: 19.08 (8.05, 24.72)mU/ml, 15.9 (4.52, 19.26)mU/ml, 12.74 (8.09, 16.23) mU/ml, H=9.85, P=0.008]. Furthermore, CX3CL1 was shown to be positively correlated with KL-6( r=0.82, P<0.001). The cutoff value for CX3CL1 was determined to be at a concentration of 9.07 ng/ml with a specificity of 86.9% and sensitivity of 43.6%. The area under the receiver operating characteristic curve was 0.603. CX3CL1 exhibited significant correlations with predcited carbon monoxide dispersion as a percentage of expected value ( r=-0.45, P=0.004), HRCT score ( r=0.54, P<0.001), pulmonary hypertension ( r=0.37, P=0.039), ESSDAI score ( r=0.36, P=0.049), as well as chest tightness and acute breath (coefficient of association r=0.49, P<0.001). Conclusion:The level of serum CX3CL1 is directly proportionate to the severity of KL-6, pulmonary fibrosis, and lung function impairment, thereby suggests that CX3CL1 can be utilized as a parameter for the diagnosis and assessment of pSS-ILD.

Objective:To explore the value of convalescent somatosensory evoked potentials (SEPs) in formulating a prognosis for children with severe disorders of consciousness (DOC) caused by brain trauma, infection or hypoxia.Methods:This was a retrospective cohort study of 286 children with DOC children treated between 2013 and 2021. They were divided into a trauma group ( n=103), an intracranial infection group ( n=101), a hypoxia group ( n=42) and an other-causes group ( n=40). Their consciousness status and functional recovery were obtained in follow-up appointments, and their functional condition 1 year after discharge was assessed using the modified Glasgow Outcome scale (GOS). Results:During 8-year follow-up, 16 had died, with 4 deaths within 1 year. Among the 191 cases followed up to 1 year, children with a bilateral N20 SEP had significantly better functional outcomes than those with unilateral or bilateral N20 absence. For the trauma group, the presence of a bilateral N20 signal was a strong indicator of good functional outcome at the 1-year follow-up, with a specificity of 90.9%, sensitivity of 55.6%, positive predictive value (PPV) of 92.6%, negative predictive value (NPV) of 50% and a positive likelihood rate (PLR) of 6.111. However, for the intracranial infection group, the presence of N20 had a low specificity for predicting good outcomes, though the absence of an N20 potential predicted poor functional outcome at 1 year with a specificity of 82.4%, sensitivity of 62.1%, PPV of 75%, and PLR of 3.517. For the hypoxic group, bilateral N20 could not predict a good prognosis, though its absence meant a poor outcome, with a specificity of 87.5%, sensitivity of 63.6%, PPV of 93.3%, and PLR of 5.818.Conclusion:SEPs during the recovery period can help to formulate a prognosis for children with severe DOC. Traumatic brain injury and the presence of bilateral N20 potentials can be used as a good prognostic indicator. For intracranial infection and hypoxic-ischemic brain injury, the absence of an N20 potential indicates a poor prognosis.

Objective:To investigate the correlation between serum ceruloplasmin level and elevated impulsivity in elderly patients with Parkinson′s disease (PD).Methods:227 elderly PD patients treated in Jinhua People′s Hospital from October 2019 to June 2021 were selected as the research objects. They were grouped according to the 75th percentile of serum ceruloplasmin. 0-75th percentile was defined as normal and >75th percentile was defined as high level. The differences of second-order and first-order factor scores of Barratt′s Impulsivity Scale Version 11 (BIS-11) between the two groups were observed. After balancing the general characteristics, the third part of Parkinson′s Disease Rating Scale (MDS-UPDRS), Hoehn&Yahr Scale, Addenbrooke Cognitive Examination Revised Edition (ACE-R), clinical treatment plan and other data, the correlation between ceruloplasmin and BIS-11 was observed.Results:According to the 75th percentile level of ceruloplasmin, 56 patients were included in the high-level group and 171 patients were included in the normal group. The level of ceruloplasmin, the ratio of female patients, MDS-UPDRS Ⅲ, Hoehn&Yahr Scale and ACE-R score in the high-level group were significantly higher than those in the normal group (all P<0.05). The second-order unplanned and corresponding first-order self-control and first-order self-knowledge complexity in the high-level group were higher than those in the normal group (all P<0.05). There was no significant difference in second-order attention, first-order attention, first-order cognitive instability, second-order motivation, first-order motivation, first-order stability and BIS-11 score between the two groups (all P>0.05). After removing the confounding factors by multifactor logistic analysis, ceruloplasmin was correlated with second-order unplanned and its corresponding first-order factors (self-control and self-knowledge complexity) (all P<0.05). Conclusions:The serum ceruloplasmin level in elderly PD patients is related to the elevated level of BIS-11 unplanned impulse.