Objective To investigate the prevalence and burden of retinoblastoma(RB)in China based on the Glob-al Burden of Disease Study 2021(GBD 2021),thus providing a theoretical foundation for the diagnosis and treatment of RB.Methods Relevant indicators such as the standardized incidence rate,standardized prevalence rate,standardized mortality rate,and standardized disability-adjusted life year(DALY)rate of RB in the total population,males,and females in China from 1990 to 2021 were analyzed to assess the prevalence and disease burden of this disease.The Joinpoint model was employed to analyze the annual percent change(APC)and the average annual percent change(AAPC)of the overall standardized incidence rate,overall standardized prevalence rate,overall standardized mortality rate,and overall standard-ized DALY rate of RB in China from 1990 to 2021.In addition,the changes in the overall standardized incidence rate,over-all standardized prevalence rate,overall standardized mortality rate,and overall standardized DALY rate were compared be-tween China and the globe from 1990 to 2021.Results Compared with 1990,the standardized incidence rate of RB in the total population,males,and females in China increased by 1.840 times,2.154 times,and 1.689 times,respectively,in 2021;the standardized prevalence rate of RB in the total population,males,and females in China increased by 1.876 times,2.133 times,and 1.701 times,respectively;the standardized mortality rate of RB in the total population,males,and fe-males in China decreased by 0.679 times,0.636 times,and 0.714 times,respectively;the standardized DALY rate of RB in the total population,males,and females in China decreased by 0.652 times,0.616 times,and 0.676 times,respectively.Joinpoint analysis showed that compared with 1990,the APPC of the overall standardized incidence rate and the overall standardized prevalence rate in China in 2021 increased by 3.21 and 3.23,respectively;the AAPC of the overall standard-ized mortality rate and the overall standardized DALY rate decreased by 3.61 and 3.46,respectively.Compared with 1990,the global overall standardized incidence rate and overall standardized prevalence rate increased by 0.237 times and 0.242 times,respectively.The global overall standardized mortality rate and overall standardized DALY rate decreased by 0.212 times and 0.195 times,respectively.Conclusion Compared with 1990,the standardized incidence rate and standardized prevalence rate of RB in the total population,males,and females in China increased in 2021,while the standardized mortal-ity rate and DALY rate decreased in 2021,indicating an increase in the prevalence of the disease but a decrease in the dis-ease burden.From 1990 to 2021,the difference between the overall standardized incidence rate and overall standardized prevalence rate in China and the global level first increased and then decreased;however,the overall standardized mortality rate and overall standardized DALY rate in China were always lower than the global level.

Objective To investigate the prevalence and burden of retinoblastoma(RB)in China based on the Glob-al Burden of Disease Study 2021(GBD 2021),thus providing a theoretical foundation for the diagnosis and treatment of RB.Methods Relevant indicators such as the standardized incidence rate,standardized prevalence rate,standardized mortality rate,and standardized disability-adjusted life year(DALY)rate of RB in the total population,males,and females in China from 1990 to 2021 were analyzed to assess the prevalence and disease burden of this disease.The Joinpoint model was employed to analyze the annual percent change(APC)and the average annual percent change(AAPC)of the overall standardized incidence rate,overall standardized prevalence rate,overall standardized mortality rate,and overall standard-ized DALY rate of RB in China from 1990 to 2021.In addition,the changes in the overall standardized incidence rate,over-all standardized prevalence rate,overall standardized mortality rate,and overall standardized DALY rate were compared be-tween China and the globe from 1990 to 2021.Results Compared with 1990,the standardized incidence rate of RB in the total population,males,and females in China increased by 1.840 times,2.154 times,and 1.689 times,respectively,in 2021;the standardized prevalence rate of RB in the total population,males,and females in China increased by 1.876 times,2.133 times,and 1.701 times,respectively;the standardized mortality rate of RB in the total population,males,and fe-males in China decreased by 0.679 times,0.636 times,and 0.714 times,respectively;the standardized DALY rate of RB in the total population,males,and females in China decreased by 0.652 times,0.616 times,and 0.676 times,respectively.Joinpoint analysis showed that compared with 1990,the APPC of the overall standardized incidence rate and the overall standardized prevalence rate in China in 2021 increased by 3.21 and 3.23,respectively;the AAPC of the overall standard-ized mortality rate and the overall standardized DALY rate decreased by 3.61 and 3.46,respectively.Compared with 1990,the global overall standardized incidence rate and overall standardized prevalence rate increased by 0.237 times and 0.242 times,respectively.The global overall standardized mortality rate and overall standardized DALY rate decreased by 0.212 times and 0.195 times,respectively.Conclusion Compared with 1990,the standardized incidence rate and standardized prevalence rate of RB in the total population,males,and females in China increased in 2021,while the standardized mortal-ity rate and DALY rate decreased in 2021,indicating an increase in the prevalence of the disease but a decrease in the dis-ease burden.From 1990 to 2021,the difference between the overall standardized incidence rate and overall standardized prevalence rate in China and the global level first increased and then decreased;however,the overall standardized mortality rate and overall standardized DALY rate in China were always lower than the global level.

Standardized training of newly recruited nurses is crucial for enhancing their clinical competencies and facilita-ting rapid adaptation to clinical environments.This approach aims to develop nursing professionals with advanced clinical skills and expertise.This paper reviews and analyzes the training paradigms for new nurses globally,focusing on the challenges faced in the standardized training of new nurses in China,to provide insights and references for future training programs.

Objective To evaluate the effectiveness of WeChat group integrating with BOPPPS instructional model in the standardized training of nurses in an orthopedics department.Methods A total of 56 nurses in orthopedical standardized training from a hospital were selected and divided into a control group(28 nurses from September 2022 to August 2023)and an interven-tion group(28 nurses trained via WeChat groups and the BOPPPS model from September 2023 to August 2024).The two groups were compared in terms of their final assessment scores,critical thinking,and self-directed learning capabilities.Results After training,the intervention group had significantly higher scores in the final assessment,all items of the California Critical Thinking Disposition Inventory,and all dimensions of the Learning Ability Assessment Scale compared to the control group(all P＜0.05).Conclusion WeChat groups combined with the BOPPPS teaching mode effectively improves the self-directed learning ability,critical thinking skills,and assessment results of orthopedic nurses.

Objective:To carry out carrier screening among people of childbearing age, detect the pathogenic genes of monogenic genetic diseases and analyze the carrier status of pathogenic variants, so as to provide fertility guidance and intervention measures for high-risk families.Methods:From August 2022 to August 2023, 1 533 families of childbearing age who met the criteria were recruited in the Chinese PLA General Hospital, including a total of 3 044 subjects. According to the standard enrollment procedure, 223 genes (197 autosomal recessive genes and 26 X-linked genes) of the subjects were tested. According to the screening results, genetic counseling and fertility guidance were provided to the subjects. Invasive prenatal diagnosis was performed for high-risk couples (both couples being carriers of the same autosomal recessive disease gene or the woman was a carrier of X-linked disease gene), and their pregnancy pattern, outcome and offspring phenotype were followed up.Results:(1) A total of 3 044 cases from 1 511 couples and women of childbearing age from 22 families were included for carrier screening. Totally 1 503 families chose simultaneous screening and 30 families chose sequential screening out of the 1 533 families. Among the 3 044 subjects, 1 603 individuals carried at least one pathogenic or likely pathogenic variant, and the overall carrier rate was 52.66% (1 603/3 044). A total of 2 292 pathogenic or likely pathogenic variants were detected, and 0.75 variants (2 292/3 044) were detected per capita. (2) The three genes with the highest carrier rates were GJB2 (8.67%, 264/3 044), CYP21A2 (3.19%, 97/3 044) and PAH (3.09%, 94/3 044). There were 32 genes with a carrier rate ≥1/200, 17 genes with a carrier rate ≥1/100, and 7 genes with a carrier rate ≥1/50. (3) Thirty-eight high-risk families were identified. After excluding G6PD gene mutation, there were 33 high-risk families, of which 25 couples were carriers of the same autosomal recessive gene, 9 women were carriers of X-linked gene, and 1 family was double high-risk couple with both autosomal recessive and X-linked gene. After further excluding the GJB2 c.109G>A mutation, 21 high-risk families were identified. Preimplantation genetic testing for monogenic disease was performed in 12 families after genetic counseling. Prenatal diagnosis was completed in 4 out of 5 high-risk families who conceived naturally. Two fetuses carried the parental variants and terminated the pregnancy, one fetus did not carry the parental variants but was induced due to trisomy 21 syndrome, and one fetus was a carrier of congenital disorders of glycosylation type 1a.Conclusions:Carrier screening effectively identifies high-risk genetic disease families and provides reproductive guidance to prevent the birth of affected children. However, establishing multidisciplinary team is essential for managing complex cases. Implementation should prioritize prenatal institutions with genetic counseling or diagnostic expertise for monogenic disorders or established referral networks.

Objective To study the types of articulation errors in children with speech sound disorders(SSD)and compare the differences in articulation between two groups according to their ages of language development(≥4 years and＜4 years).Methods A comprehensive assessment was conducted on 260 children with SSD who visited the outpatient department between May 2022 and May 2023.The S-S method for delayed language development e-valuation and the Gesell developmental schedules were used.Based on their assessed language developmental age,130 children from each age group(≥4 years and＜4 years)were selected.All participants underwent speech articu-lation assessment using the Word List developed by Huang Zhaoming and Han Zhijuan.The types of consonant and vowel mispronunciations were compared between the two groups,and statistical analysis were performed using SPSS 26.0 software to determine differences in speech articulation.Results Apart from distortions,the most common type of consonant mispronunciation in both age groups was frontalization,while the most frequent type of vowel mispronunciation was final sound omission.The occurrence frequency and composition ratio of consonant and vowel mispronunciations were similar in both age groups,and there was no significant difference in speech articulation be-tween the two groups of children.Conclusion Early intervention is crucial for children with SSDs at different lan-guage developmental stages(≥4 years and＜4 years)to prevent the solidification of incorrect articulation patterns.

Objective To study the types of articulation errors in children with speech sound disorders(SSD)and compare the differences in articulation between two groups according to their ages of language development(≥4 years and＜4 years).Methods A comprehensive assessment was conducted on 260 children with SSD who visited the outpatient department between May 2022 and May 2023.The S-S method for delayed language development e-valuation and the Gesell developmental schedules were used.Based on their assessed language developmental age,130 children from each age group(≥4 years and＜4 years)were selected.All participants underwent speech articu-lation assessment using the Word List developed by Huang Zhaoming and Han Zhijuan.The types of consonant and vowel mispronunciations were compared between the two groups,and statistical analysis were performed using SPSS 26.0 software to determine differences in speech articulation.Results Apart from distortions,the most common type of consonant mispronunciation in both age groups was frontalization,while the most frequent type of vowel mispronunciation was final sound omission.The occurrence frequency and composition ratio of consonant and vowel mispronunciations were similar in both age groups,and there was no significant difference in speech articulation be-tween the two groups of children.Conclusion Early intervention is crucial for children with SSDs at different lan-guage developmental stages(≥4 years and＜4 years)to prevent the solidification of incorrect articulation patterns.

Objective To explore the relationship between serum chitosinase 3-like protein 1(CHI3L1)and Syndecan-1(SDC1)levels and bone metabolism in elderly patients with type 2 diabetes mellitus and their predictive efficacy on osteoporosis.Methods A total of 412 elderly patients with type 2 diabetes admitted to this hospital from May 2019 to May 2023 were included in this study,and were divided into normal bone mass group(n=151),reduced bone mass group(n=138)and osteoporosis group(n=123)according to the iffer-ences in bone mineral density.Serum CHI3L1 and SDC1 levels were detected by enzyme-linked immunosor-bent assay,and serum levels of type 1 collagen cross-linked carboxyl terminal peptide(CTX),25-hydroxyvita-min D[25-(OH)D],osteocalcin(OC),and type 1 procollagen N-terminal propeptide(P1NP)were deter-mined by automatic chemiluminescence immunoassay.Pearson correlation analysis was used to investigate the relationship between serum CHI3L1,SDC1 and bone metabolism in elderly patients with type 2 diabetes.Re-ceiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum CHI3L1 and SDC1 on osteoporosis in elderly patients with type 2 diabetes.Multivariate Logistic regression analysis was used to investigate the influencing factors of osteoporosis in elderly patients with type 2 diabetes.Results There were significant differences in diabetes course,fasting blood glucose,HbA1c and HDL-C a-mong normal bone mass group,decreased bone mass group and osteoporosis group(P＜0.05).The levels of serum CHI3L1,25-(OH)D,P1NP and osteocalcin in osteoporosis group were lower than those in osteopenia group,and those in osteopenia group were lower than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum SDC1 and CTX levels in osteoporosis group were higher than those in osteopenia group,and those in osteopenia group were higher than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum CHI3L1 was positively correlated with 25-(OH)D,P1NP and OC(P＜0.05),and negatively correlated with CTX(P＜0.05).Serum SDC1 was negatively correlated with 25-(OH)D,P1NP,OC(P＜0.05),and positively correlated with CTX(P＜0.05).The area under the curve(AUC)of serum CHI3L1,SDC1 and their combination predicted osteoporosis in elderly pa-tients with type 2 diabetes were 0.851,0.772 and 0.904,respectively.Multivariate Logistic regression analysis showed that long duration of diabetes,increased HbA1c,high expression of OC,CHI3L1＞4.16 ng/mL,SDC1≥50.94 ng/mL were all influential factors for osteoporosis in elderly patients with type 2 diabetes(P＜0.05).Conclusion Low expression of CHI3L1 and high expression of SDC1 in serum are associated with ab-normal bone metabolism in elderly patients with type 2 diabetes.These two indexes are expected to be used as biological markers to predict osteoporosis in elderly patients with type 2 diabetes.

OBJECTIVE: To compare the effects of different chest compression rates (60-140 times/min) on hemodynamic parameters, return of spontaneous circulation (ROSC), resuscitation success, and survival in a porcine model of cardiac arrest (CA) followed by cardiopulmonary resuscitation (CPR). METHODS: Forty healthy male domestic pigs were randomly divided into five groups based on chest compression rate: 60, 80, 100, 120, and 140 times/min (n = 8). All animals underwent standard anesthesia and tracheal intubation. A catheter was inserted via the left femoral artery into the thoracic aorta to monitor aortic pressure (AOP), and another via the right external jugular vein into the right atrium to monitor right atrial pressure (RAP). In each group, animals were implanted with a stimulating electrode via the right external jugular vein to the endocardium, and ventricular fibrillation (VF) was induced by delivering alternating current stimulation, resulting in CA. After a 1-minute, manual chest compressions were performed at the assigned rate with a compression depth of 5 cm. The first defibrillation was delivered after 2 minutes of CPR. No epinephrine or other pharmacologic agents were administered during the entire resuscitation process. From 1 minute before VF induction to 10 minutes after ROSC, dynamic monitoring of AOP, coronary perfusion pressure (CPP), and partial pressure of end-tidal carbon dioxide (P_ETCO₂). Cortical ultrastructure was examined 24 hours post-ROSC using transmission electron microscopy. RESULTS: With increasing compression rates, both the total number of defibrillations and cumulative defibrillation energy significantly decreased, reaching their lowest levels in the 120 times/min group. The number of defibrillations decreased from (4.88±0.83) times in the 60 times/min group to (2.25±0.71) times in the 120 compressions/min group, and energy from (975.00±166.90)J to (450.00±141.42)J. However, both parameters increased again in the 140 times/min group [(4.75±1.04)times, (950.00±207.02)J], the differences among the groups were statistically significant (both P < 0.01). As compression frequency increased, P_ETCO₂, pre-defibrillation AOP and CPP significantly improved, peaking in the 120 times/min group [compared with the 60 times/min group, P_ETCO₂ (mmHg, 1 mmHg≈0.133 kPa): 18.69±1.98 vs. 8.67±1.30, AOP (mmHg): 95.13±7.06 vs. 71.00±6.41, CPP (mmHg): 14.88±6.92 vs. 8.57±3.42]. However, in the 140 times/min group, these values declined significantly again [P_ETCO₂, AOP, and CPP were (10.59±1.40), (72.38±11.49), and (10.36±4.57) mmHg, respectively], the differences among the groups were statistically significant (all P < 0.01). The number of animals achieving ROSC, successful resuscitation, and 24-hour survival increased with higher compression rates, reaching a peak in the 120 times/min group (compared with the 60 times/min group, ROSC: 7 vs. 2, successful resuscitation: 7 vs. 2, 24-hour survival: 7 vs.1), then decreased again in the 140 times/min group (the animals that ROSC, successfully recovered and survived for 24 hours were 3, 3, and 2, respectively). Transmission electron microscopy revealed that in the 60, 80, and 140 times/min groups, nuclear membranes in cerebral tissue were irregular and incomplete, nucleoli were indistinct, and mitochondria were swollen with reduced cristae and abnormal morphology. In contrast, the 100 times/min and 120 times/min groups exhibited significantly attenuated ultrastructural damage. CONCLUSIONS Among the tested chest compression rates of 60-140 times/min, a chest compressions frequency of 120 times/min is the most favorable hemodynamic profile and outcomes during CPR in a porcine CA model. However, due to the wide spacing between groups, further investigation is needed to determine the optimal compression rate range more precisely.
Animals ; Cardiopulmonary Resuscitation/methods* ; Swine ; Male ; Heart Arrest/therapy* ; Heart Massage/methods* ; Hemodynamics

Objective:To carry out carrier screening among people of childbearing age, detect the pathogenic genes of monogenic genetic diseases and analyze the carrier status of pathogenic variants, so as to provide fertility guidance and intervention measures for high-risk families.Methods:From August 2022 to August 2023, 1 533 families of childbearing age who met the criteria were recruited in the Chinese PLA General Hospital, including a total of 3 044 subjects. According to the standard enrollment procedure, 223 genes (197 autosomal recessive genes and 26 X-linked genes) of the subjects were tested. According to the screening results, genetic counseling and fertility guidance were provided to the subjects. Invasive prenatal diagnosis was performed for high-risk couples (both couples being carriers of the same autosomal recessive disease gene or the woman was a carrier of X-linked disease gene), and their pregnancy pattern, outcome and offspring phenotype were followed up.Results:(1) A total of 3 044 cases from 1 511 couples and women of childbearing age from 22 families were included for carrier screening. Totally 1 503 families chose simultaneous screening and 30 families chose sequential screening out of the 1 533 families. Among the 3 044 subjects, 1 603 individuals carried at least one pathogenic or likely pathogenic variant, and the overall carrier rate was 52.66% (1 603/3 044). A total of 2 292 pathogenic or likely pathogenic variants were detected, and 0.75 variants (2 292/3 044) were detected per capita. (2) The three genes with the highest carrier rates were GJB2 (8.67%, 264/3 044), CYP21A2 (3.19%, 97/3 044) and PAH (3.09%, 94/3 044). There were 32 genes with a carrier rate ≥1/200, 17 genes with a carrier rate ≥1/100, and 7 genes with a carrier rate ≥1/50. (3) Thirty-eight high-risk families were identified. After excluding G6PD gene mutation, there were 33 high-risk families, of which 25 couples were carriers of the same autosomal recessive gene, 9 women were carriers of X-linked gene, and 1 family was double high-risk couple with both autosomal recessive and X-linked gene. After further excluding the GJB2 c.109G>A mutation, 21 high-risk families were identified. Preimplantation genetic testing for monogenic disease was performed in 12 families after genetic counseling. Prenatal diagnosis was completed in 4 out of 5 high-risk families who conceived naturally. Two fetuses carried the parental variants and terminated the pregnancy, one fetus did not carry the parental variants but was induced due to trisomy 21 syndrome, and one fetus was a carrier of congenital disorders of glycosylation type 1a.Conclusions:Carrier screening effectively identifies high-risk genetic disease families and provides reproductive guidance to prevent the birth of affected children. However, establishing multidisciplinary team is essential for managing complex cases. Implementation should prioritize prenatal institutions with genetic counseling or diagnostic expertise for monogenic disorders or established referral networks.