Objective: To discuss the diagnosis, treatment, and multidisciplinary management of a child with hepatoblastoma (HB) and suspected coronavirus disease (COVID-19). Methods: A child with HB and suspected COVID-19 was admitted to the Children's Hospital, Zhejiang University School of Medicine, in February 2020. The diagnosis and treatment plan were discussed by a multidisciplinary team (MDT). After the MDT discussion, necessary examinations and tests were performed, including routine blood tests, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) and antibody tests, tumor marker tests, chest and abdomen computed tomography (CT), and an ultrasound. The administered treatment included the cisplatin+5-fluorouracil+vincristine (C5V) regimen and cefotaxime. Results: The patient was diagnosed as low-risk HB and completed the first stage of HB chemotherapy after the diagnosis of COVID-19 was ruled out. After 1 week in the hospital, the patient's body temperature returned to normal, the disposition and appetite improved, and all indexes reached the discharge standard. After 14 days of isolation, the patient was discharged. Conclusions: For children with newly diagnosed HB suspected of having COVID-19 during the pandemic period, clinicians must consider the prevention and control of COVID-19 while diagnosing and treating HB as soon as possible. Multidisciplinary management is beneficial for ensuring the development of a safe and efficient treatment plan.

Objective To evaluate the effect of transcutaneous neuromuscular electrical stimulation on prevention of intensive care unit-acquired weakness (ICU-AW) in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation. Methods A prospective randomized controlled study was conducted. Sixty COPD patients aged 18-85 years old who were accepted mechanical ventilation therapy admitted to general intensive care unit (ICU) of the First Affiliated Hospital of Hunan University of Medicine from October 2017 to October 2018 were enrolled. Patients were divided into control group (n = 30) and intervention group (n = 30) by random number table method. All patients were accepted routine treatment, and on this basis, the intervention group was applied transcutaneous neuromuscular electrical stimulation on the extremities (twice a day, 30 minutes each time) after 24 hours of admission until ICU discharge. The Medical Research Council muscle strength score (MRC-Score), grip strength, incidence of ICU-AW on the 7th day after admission and on the day of ICU discharge; modified Barthel index score on the day of ICU discharge; and duration of mechanical ventilation, the length of ICU stay, and the length of hospital stay were compared between the two groups. Results Twenty-nine and 27 patients in the control group and the intervention group respectively finally completed the study in dividually. There was no significant difference in gender, age, Barthel index score before 2 weeks of ICU admission, body mass index or acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in ICU between the two groups. There was no significant difference in the MRC-Score, grip strength or incidence of ICU-AW on the 7th day after ICU admission between the two groups. Compared to the control group, the MRC-Score, grip strength and Barthel index score in the intervention group were significantly increased [MRC-Score: 55.97±8.43 vs. 46.32±7.36, grip strength (kg): 33.46±11.62 vs. 27.42±9.64, Barthel index score:46.04±5.46 vs. 42.13±3.32, all P < 0.05], the incidence rate of ICU-AW was significantly decreased [7.4% (2/27) vs. 31.0% (9/29), P < 0.05], and duration of mechanical ventilation, the length of ICU stay, the length of hospital stay were significantly shortened [duration of mechanical ventilation (days): 5.12±2.01 vs. 7.24±4.35, the length of ICU stay (days): 8.34±2.36 vs. 10.45±2.62, the length of hospital stay (days): 13.21±2.21 vs. 15.38±3.67, all P < 0.05]. Conclusion Transcutaneous neuromuscular electrical stimulation can effectively improve the muscle strength of COPD patients with mechanical ventilation and reduce the incidence of ICU-AW.

OBJECTIVETo analyze the ultra microstructures and the expression of platelet peroxidase (PPO) of megakaryocytes from bone marrow, their clinical manifestations and laboratory characteristics in patients with acute megakaryoblastic leukemia (AMKL).

METHODSKaryocytes from bone marrow of 22 AMKL patients were divided into two parts by lymphocyte separation liquid, one part was used to prepare the ordinary transmission electron microscope specimens to observe the morphological structures of megakaryocytes, the other was used to prepare the histochemical specimens of platelet peroxidase to analyze the positive reaction of PPO in AMKL, which were coupled with the patients' data of with bone marrow morphology, cell chemistry, and chromosome karyotype examination.

RESULTSMegakaryocytes from 17 of 22 patients were in the first stage, less than 20 µm in diameter, the nucleis were round, the cytoplasm contained microtubules, membranous vesicles and minute dense granules, no demarcation membrane system and surface-connected canalicular system, less dense granules and α-granules; Megakaryocytes in 5 cases were mainly in the first stage, while containing second and third stage megakaryocytes; the positive rate of PPO in megakaryocytes of 22 patients was 0-80%. The primitive and naive megakaryocytes were found in bone marrow smears of 22 cases, CD41 staining of the megakaryocytes was detected in the primitive and naive megakaryocytes, and more complex chromosome karyotype anomalies were observed.

CONCLUSIONThe majority of megakaryocytes in AMKL patients were the first stage ones, the rest were second and third stage ones, and the positive PPO reaction was significantly different. CD41 staining of the megakaryocytes was specific with complex chromosome karyotypeswere.

Blood Platelets ; enzymology ; Bone Marrow ; pathology ; Cell Count ; Chromosome Aberrations ; Chromosome Disorders ; Humans ; Karyotyping ; Leukemia, Megakaryoblastic, Acute ; diagnosis ; pathology ; Megakaryocytes ; pathology ; Peroxidase ; metabolism ; Staining and Labeling

Objective:To explore the chain mediation role of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness.Methods:From February to March 2024, a convenience sampling method was used to select 763 nurses from ClassⅢ Grade A hospitals in Wenzhou as research subjects. Data were collected using a General Information Questionnaire, the Occupational Embeddedness Scale for Nurses (OESN), the Nursing Professional Values Scale-Revised (NPVS-R), the Nurses' Career Planning Questionnaire (NCPQ), and the Career Success Scale for Nurses (CSSN). Pearson correlation analysis was performed to examine the correlations among the scores of OESN, NPVS-R, NCPQ, and CSSN. The AMOS 21.0 software was used to construct a structural equation model to explore the chain mediation role of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness.Results:A total of 763 questionnaires were collected, with 749 valid responses, resulting in an effective recovery rate of 98.17%. The average scores for the 749 nurses were as follows: OESN (60.29±7.65), NPVS-R (108.99±11.82), NCPQ (42.98±4.44), CSSN (73.57±8.34). All four scale scores were positively correlated with each other ( P<0.05). The chain mediation effect of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness was established, with the total indirect effect accounting for 46.04% (0.302/0.656) of the total effect and the chain mediation effect of career development planning and career success accounting for 10.21% (0.067/0.656) . Conclusions:The level of occupational embeddedness among nurses needs further improvement. Nurses' professional values not only directly influence their level of occupational embeddedness but also affect their career development planning, which in turn impacts their career success, ultimately exerting an indirect effect on occupational embeddedness. Nursing managers should strengthen nurses' professional values, assist them in formulating clear career development plans, and provide timely feedback and recognition of career success.

Objective:To investigate the clinical and epidemiological features of acute respiratory adenovirus infection in children.Methods:Clinical data of 488 children with acute respiratory tract human adenovirus (HAdV) infection admitted in Children’s Hospital of Zhejiang University School of Medicine from September 2018 to August 2019 were retrospectively analyzed. Nasopharyngeal swabs or nasopharyngeal aspirates (NPAs) were collected and tested by direct immunofluorescence assay. Kruskal Wallis H test was used for quantitative data without normal distribution, and P<0.05 was considered to be statistically significant. The qualitative data were compared by chi-square test or Fisher’s exact test. Bonfereoni chi-square segmentation was performed for comparison between groups, and P<0.007 was considered statistically significant after correction. Results:A total of 488 HAdV positive cases were detected from 7 072 patients with acute respiratory tract infection (6.9%), including 305 males (62.5%) and 183 females (37.5%). The median age of HAdV positive children was 43 months (39 days to 12 years). The detection rate in 6 m-<2 y age group(8.7%, 123/1 408)was significantly higher than those in <6 m group (3.0%, 6/197)and ≥5 y group(4.6%, 89/1 948)( χ2=7.57, 23.98, P all <0.007). The detection rate in 2-<5 y group(7.7%, 270/3 519)was significantly higher than those in <6 m group and ≥5 y group ( χ2=5.809, 19.688, P all <0.007). The peak rate was detected in the winter [12.9%(238/1 840)] which was significantly higher than those in spring (4.7%), summer (3.9%), and autumn(5.5%)( χ2=103.477, 58.986 and 49.926, P<0.007). The average length of hospital stay was (6±4)d(1-41 d). 486 cases (99.5%) were discharged from hospital after treatment, and 2 cases died. There were 111 cases (22.7%) of acute upper respiratory tract infection, 34 cases (7.0%) of bronchitis and 343 cases (70.3%) of pneumonia; and severe pneumonia was diagnosed in 86 cases (25.1%, 86/343). The common clinical manifestations were fever 93.4% (456/488), cough 94.7% (462/488), wheezing 26.2% (128/488) and shortness of breath 14.8% (72/488). 138 cases (28.3%) had extrapulmonary symptoms, 78 cases (16.0%) had underlying diseases, among which congenital heart disease was most common (16, 3.3%). The average duration of fever was(8.8±2.4)d(5-17 d)in 456 fever cases, the duration between 7-10 d in 277 cases and >10 d in 96 cases; and 439 cases had hyperpyrexia(≥39 ℃). The single infection occurred in 275 (56.4%) cases and mixed infection in 213(43.6%) cases. The proportions of fever, hyperpyrexia, fever duration >10 d, severe pneumonia, wheezing and length of hospital stay in mixed infection group were significantly higher than those in the single infection group ( χ2/ Z=11.960, 6.494, 37.209, 72.841 and -8.805, P all <0.05). The length of hospital stay, proportion of fever time>10 d, wheezing, shortness of breath, hypersomnia/poor spirits, serous effusion, extrapulmonary symptoms, mixed infection, and underlying diseases in severe pneumonia group were significantly higher than those in the mild pneumonia group ( χ2/ Z=-9.182, 23.825, 49.094, 143.627, 219.659, 81.327, 8.080, 21.546 and 10.556, P all <0.05). The proportion of severe pneumonia in 6 m to <2 y group was higher than that in 2-<5 y group and ≥5 y group( χ2=20.709, 8.603, P all <0.007). Conclusions:HAdV is an important pathogen of acute respiratory infection in children. HAdV infection occurs mainly in children aged from 6 month to 2 years and has a high detection rate in winter. Children aged 6 months to 2 years with wheezing, shortness of breath, underlying diseases, extrapulmonary symptoms and mixed infections are more likely to develop severe pneumonia.

Objective: To investigate the clinic-pathological features, diagnosis and treatment of 8p11 myeloproliferative syndrome (EMS) . Methods: Five patients diagnosed as EMS from Jan 2014 to May 2018 at Blood Disease Hospital, Chinese Academy of Medical Sciences were enrolled. The clinical manifestations, laboratory characteristics, treatment and outcome of these patients were summarized. Results: The peripheral blood leukocyte count of 5 patients with EMS increased significantly, accompanied with an elevated absolute eosinophils value (the average as 18.89×10⁹/L) . The hypercellularity of myeloid cells was common in bone marrow, always with the elevated proportion of eosinophils (the average as 17.24%) , but less than 5% of blast cells. The chromosome karyotype of the 5 cases differed from each other, but presenting with the same rearrangement of FGFR1 gene by fluorescence in situ hybridization technology. The average interval between onset and diagnosis was 4.8 months with a median survival of only 14 months. Conclusion EMS was a rare hematologic malignancy with poor prognosis and short survival. It was commonly to be misdiagnosed. Analysis of cytogenetics and molecular biology were helpful for early diagnosis.

Objective:To investigate the clinical characteristics, etiology, and prognosis of familial acute myeloid leukemia (AML) with germline CEBPA mutation and improve the understanding of familial leukemia.Methods:The age of onset, clinical characteristics, outcome, and prognosis of a family of patients with AML were investigated, and the family tree of the cases was displayed. Bone marrow and oral mucosal cells were collected from the proband, and peripheral blood was collected from the relatives of the proband. Gene mutation was detected by gene sequencing technology.Results:A total of 10 patients in this family were diagnosed with acute leukemia, including 4 males and 6 females, with a median age of 9 (3-48) years. Of the 10 patients, six died. Among them, 4 patients did not receive treatment, 1 patient survived 3 years after chemotherapy and died of relapse, and one patient died 2 years after receiving traditional Chinese medicine and supportive treatment. Four patients are alive. One patient has survived 15 years through chemotherapy, and three patients have survived with chemotherapy combined with hematopoietic stem cell transplantation, and the survival time was 6, 9, and 28 months at the end of follow-up. Gene sequencing was performed on proband and 8 relatives of the proband, and 5 were found to have the germline CEBPA TAD p.G36Afs*124 mutation. Among the 5 individuals with confirmed CEBPA mutation, 4 were diagnosed with AML, and 1 had not developed disease during follow-up.Conclusion:AML with germline CEBPA gene mutation mostly occurs in children and young adults, with complete or nearly complete penetrance. With active treatment, most of the patients have a favorable prognosis.