Objective To explore the diagnostic and therapeutic strategies of bladder carcinosarcoma, so as to provide clinical reference. Methods This article reported a case of bladder urothelial carcinoma with spindle cell malignant tumor and giant-cell osteosarcoma differentiation in the Department of Urology of the First People's Hospital of kunshan. Based on literature analysis, the clinical characteristics, diagnostic methods, treatment plan of the disease were analyzed. Results The patient, a 75-year-old male, was admitted due to three months of painless gross hematuria, The abdominal enhanced CT scan revealed an irregular solid mass on the left wall of the bladder, measured approximately 6 cm×7 cm, which showed significant enhancement after contrast administration. Biopsy pathology indicated transitional cell carcinoma of the urothelium with squamous metaplasia and moderate atypical hyperplasia, with spindle-shaped cells in the stroma showing bizarre nuclei. Under general anesthesia, the patient received transurethral resection of the bladder tumor. Postoperative pathology showed lowgrade urothelial carcinoma of the bladder with squamous metaplasia, complicated with malignant spindle-cell tumor, which had osteosarcoma-like giant-cell differentiation, suggesting a diagnosis of carcinosarcoma of the bladder. The patient received intravesical gemcitabine treatment for two years postoperatively, with regular follow-ups. No tumor recurrence was observed over four years, and he is still alive. Combined with previous published literature, the disease is mostly manifested as painless gross hematuria. If the submucosa or muscle layer is invaded, the patient will quickly develop tumor recurrence and metastasis. The diagnosis depends on pathology, and the treatment is mainly radical cystectomy combined with chemoradiotherapy. Conclusion Bladder carcinosarcoma is an extremely rare subtype of bladder cancer. This highly aggressive malignancy primarily affects elderly patients. The current standardized treatment involves radical cystectomy combined with chemotherapy and radiotherapy.For some early-stage cases, intravesical chemotherapy after tumor resection may be more appropriate.

Objective:To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants.Methods:This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children′s Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with χ2 test or continuity-corrected χ2 test or Fisher′s exact test, independent-samples t test, Mann-Whitney U test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. Results:There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 st minute and 5 th minute and days of breastfeeding during the first 3 weeks of life (all P>0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both P<0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all P<0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both P<0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis ( OR=11.50, 95% CI 1.94-68.30, P=0.007) and severe intraventricular hemorrhage ( OR=6.82, 95% CI 1.19-38.97, P=0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10 9/L vs. (119±14)×10 9/L, t=5.37, P<0.001). Conclusions:Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.

Objective:To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants.Methods:This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children′s Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with χ2 test or continuity-corrected χ2 test or Fisher′s exact test, independent-samples t test, Mann-Whitney U test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. Results:There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 st minute and 5 th minute and days of breastfeeding during the first 3 weeks of life (all P>0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both P<0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all P<0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both P<0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis ( OR=11.50, 95% CI 1.94-68.30, P=0.007) and severe intraventricular hemorrhage ( OR=6.82, 95% CI 1.19-38.97, P=0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10 9/L vs. (119±14)×10 9/L, t=5.37, P<0.001). Conclusions:Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.

Obiective:To compare characteristics of alveolar macrophages(AMs)or AM-like cells in vitro cultured from different progenitors in mice of different ages in presence of GM-CSF,TGF-β and PPAR-γ agonist rosiglitazone(in brief,GTR),according to a previously reported optimized culture procedure.Methods:After bronchoalveolar lavage fluid(BALF)and bone marrow were isolated from mice of different ages and fetal livers were isolated from embryonic-day-15～17 mice,mononuclear cells were seeded into 12-well plates and cultured in presence of GTR.Generated cells were subjected to flow cytometry analysis to analyze expressions of AM markers F4/80,CD11b,CD170 and CD11c.Results:After culture,almost all BALF-derived cells were round-shaped under light microscope,about half bone marrow-derived cells appeared round-shaped,and about 85% fetal liver-derived cells showed round-shaped morphology.Frequency of BALF-AMs from 4-week-old mice was nearly 90%.Frequency and number of BALF-AMs increased with age of mice.Number of BALF-AMs from 12-week-old mice was nearly 1×106.Frequency of bone marrow-derived AM-like cells from 4-week-old mice was lower than 20% and increased to about 40%～45% for 8-week-old and 12-week-old mice.Number of bone marrow-derived AM-like cells increased with age of mice,and about 0.8×106 cells/well bone marrow-derived AM-like cells were produced from 12-week-old mice.Frequency of fetal liver-derived AM-like cells was around 84% and their number could reach 4×106 cells/well.Conclusion:Purity and number of AMs or AM-like cells in vitro cultured from different progenitors in mice of different ages vary dramatically.Detailed condition should be chosen according to specific study requirements.

Objective To analyze the clinical features of children with EV71 positive hand,foot,and mouth disease(HFMD)and EV71 vaccination,and to explore the relationship between the occurrence of severe disease and the preventive effect of EV71 vaccine.Methods From January 1,2020 to December 31,2022,the clinical data of 131 children with HFMD diagnosed with EV71 infection in Kunming Children's Hospital were retrospectively analyzed.The stool samples of patients with clinically confirmed HFMD were selected for enterovirus nucleic acid detection.The clinical data and EV71 vaccination status of children with universal enterovirus positive and EV71 positive HFMD were analyzed.Results Among the 131 positive cases detected,there were 116 mild cases and 15 severe cases.Among the 80 children who received phone consultations about their EV71 vaccine status,17 were vaccinated,and 63 were not vaccinated.The vaccinated children were all mild cases,while among the unvaccinated children,6 were severe cases.From 2020 to 2022,the period from April to September each year is the peak period for detecting EV71-positive hand,foot,and mouth disease(χ2 = 125.705,P = 0.000).The positive detection rate for children under 1 year old and over 5 years old was higher than that for children aged 1 to 5 years(χ2 = 8.765,P = 0.033),and there was no significant difference in the positive detection rate between boys and girls(χ2 = 1.221,P = 0.269).Conclusion EV71 vaccine is of great significance in reducing the occurrence of severe cases.Combined with the current low vaccination rate in Kunming,Yunnan Province,it is suggested that relevant institutions should continue to increase the publicity of EV71 vaccination.

Objective:To establish a mice model of inflammatory bowel disease (IBD) induced by dextran sulfate sodium (DSS), and to analyze the changes in intestinal inflammation and macrophage subsets at different stages, so as to find a new target for the treatment of IBD.Methods:Thirty male C57BL/6 mice of 6-8 weeks were randomly divided into control group, activation stage group and resolution stage group.The latter 2 groups were given 25 g/L DSS for 5 consecutive days to establish the IBD model.After 5 days, the mice were given filtered and sterilized water and sacrificed on the 10 th and 15 th day, respectively.Colon inflammation in mice was evaluated, including body weight, disease activity index (DAI) score, changes in colon length, histopathology and histopathological score.Then the expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β in colon tissues were detected by quantitative real-time PCR(qPCR). Finally, the changes of intestinal macrophage subsets were detected by flow cytometry. Results:The colon inflammation of mice in the activation stage group was significantly more severe than that in the control group, while the colon inflammation of mice in the resolution stage group was reduced.The colon length of mice in the activation stage group was (5.94±0.40) cm, which was significantly shorter than that in the control group [(7.25±0.29) cm], and the situation was slightly improved in the resolution stage with the colon length of [(6.87±0.95) cm], and the differences were statistically significant (all P<0.05). The mRNA expression levels of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α in the activation stage were 53.40±6.58, 117.69±30.78 and 2.52±0.25, respectively, which were significantly higher than those in the control group (1.00±0.13, 1.00±0.39, 1.00±0.10); the mRNA expression levels of IL-1β, IL-6 and TNF-α in the resolution stage were 2.51±0.13, 5.43±0.51 and 1.73±0.14, respectively, which were significantly lower than those in the activation stages(all P<0.05). The expression level of anti-inflammatory cytokine TGF-β in the resolution stage was 2.41±0.17, which was significantly higher than that in the activation stage (0.94±0.12), and the diffe-rence was statistically significant ( P<0.05). During the progression of IBD, there were 3 groups of macrophages in the lamina propria of intestinal mucosa of mice, of which the number of F4/80 lowCD 64-MHCⅡ - macrophage subset with the lowest maturity increased significantly in the activation stage of IBD, accounting for (10.68±4.62)%, and it decreased and returned to the normal level in the resolution stage, accounting for (4.63±1.06)%, and the difference was statistically significant ( P<0.05). Conclusions:Macrophages play an important role in the progression of IBD, the hindrance of maturation and development may be the main cause of inflammatory injury in the activation stage of IBD, and the transformation of macrophage subsets may become a new target for the treatment of IBD.

Objective:To explore the significance of plasma homocysteine (Hcy) as a new biomarker for the differential diagnosis of postural tachycardia syndrome (POTS) and suspected myocarditis in children.Methods:A total of 24 children diagnosed with POTS and 21 children diagnosed with suspected myocarditis treated in the Pediatrics Department of the Peking University First Hospital from July to December 2016 were included in the study.Plasma Hcy levels were measured in each subject and compared between children with POTS and suspected myocarditis.The receiver operating characteristic (ROC) curves were depicted for assessing the diagnostic potential of Hcy in distinguishing POTS from suspected myocarditis.Results:Plasma Hcy level in the POTS group was significantly higher than that in the suspected myocarditis group [(14.25±8.09) μmol/L vs.(8.99±3.19) μmol/L], which was also significantly higher than that of the mean levels in Beijing children [(8.82±5.58) μmol/L] (all P<0.05). When the cut-off was 9.36 μmol/L, the area under the ROC curve was 0.76, and the sensitivity and specificity for distinguishing POTS from suspected myocarditis were 71% and 68%, respectively. Conclusions:Plasma Hcy levels are helpful in the differential diagnosis of POTS and suspected myocarditis in children.

ObjectiveTo investigate the effect of motivational interviewing on health literacy and quality of life of patients on maintenance hemodialysis. MethodsUsing convenience sampling method, 100 patients on maintenance hemodialysis were selected from March 2016 to March 2018 in a blood purification center of a Class Ⅲ Grade A hospital. According to dialysis time, the patients were divided into the intervention group (n=50) and control group (n=50). Motivational interviews were conducted in the intervention group. Traditional health education methods were used in the control group. The two groups' scores in health literacy and quality of life from Health Literacy of Patients with Chronic Diseases Questionnaire and Kidney Disease Questionnaire(KDQ) before and after intervention were compared. ResultsAfter 6 months of intervention, the total score of health literacy in the intervention group increased from (87.34±2.85) to (97.34±3.02). The scores of three dimensions of "information acquisition ability", "communication and interaction ability" and"willingness to improve health" were higher than those before intervention, and the total score of health literacy and above three dimensions in the intervention group were higher than those in the control group with statistical differences (P＜0.05). The total score of quality of life in the intervention group increased from (100.64±17.62) to (115.60±16.15), among which the scores of "somatic symptoms", "fatigue" and "relationship with others"in the intervention group were higher than those before intervention, and the total score of quality of life and the above three dimensions in the intervention group were higher than those in the control group, the differences were statistically significant (P＜0.05). ConclusionsMotivational interviews can improve the health literacy level of maintenance hemodialysis patients, enhance their awareness of improving health, change their bad behaviors, and improve their quality of life.

Objective To establish a scale integrated Chinese and Western medicine for predicting the progress of diabetic kidney disease(DKD),and provide a simple and reliable predictive method for DKD progress.Methods DKD patients were divided into group of microalbuminuria stage(MAU group,n=258)and group of clinical albuminuria stage(CAU group, n=234).The basic information, detected indexes,laboratory indexes and distribution of TCM pattern factors were compared between 2 groups.The risk factors were screened by using multi-factor Logistic regression analysis,and a regression equation was obtained with Western medical indexes and TCM pattern factors as variables.The continuous variables were converted to categorical variables by using decision tree method to establish a predictive scale of DKD progress.There were 76 DKD patients in MAU group were re-chosen,and the predictive scale was verified according to their actual progress of DKD.Results The results of Logistic regression analysis showed that systolic blood pressure(OR=1.021,P=0.022),albumin(OR=0.888,P=0.000),se-rum creatinine(OR=1.010, P=0.000), blood uric acid(OR=1.004, P=0.000)and yang defi-ciency pattern(OR=1.793, P=0.006)were independently correlated to DKD developing from MAU stage to CAU stage.The total score of the scale was 86,and diagnostic threshold value was 42.The area under the ROC curve was 0.852,and small sample validation showed that sensitivity was 60%,specifici-ty was 78.8%and accuracy rate was 76.3%.Conclusion The scale can well predict the probability of DKD developing from MAU stage to CAU stage,which is meaningful to the early prediction of DKD.

This article summarized perioperative nursing experience of 6 patients underwent percutaneous microwave or radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy(PALPP).The key points of nursing included:psychological counseling applied throughout the perioperative treatment;personalized preoperative biliary drainage;nursing intervention targeting at Enhanced Recovery After Surgery(ERAS);complication-directed prevention and nursing after microwave or radiofrequency ablation,portal vein embolization,and radical hepatectomy.All 6 patients were recovered and discharged successfully.