Objective:To determine the total and age-specific cut-off values of total prostate specific antigen (tPSA) and the ratio of free PSA divided total PSA (fPSA/tPSA) for screening prostate cancer in China.Methods:Based on the Chinese Colorectal, Breast, Lung, Liver, and Stomach cancer Screening Trial (C-BLAST) and the Tianjin Common Cancer Case Cohort (TJ4C), males who were not diagnosed with any cancers at baseline since 2017 and received both tPSA and fPSA testes were selected. Based on Cox regression, the overall and age-specific (＜60, 60-＜70, and ≥70 years) accuracy and optimal cut-off values of tPSA and fPSA/tPSA ratio for screening prostate cancer were evaluated with time-dependent receiver operating characteristic curve (tdROC) and area under curve (AUC). Bootstrap resampling was used to internally validate the stability of the optimal cut-off value, and the PLCO study was used to externally validate the accuracy under different cut-off values.Results:A total of 5 180 participants were included in the study, and after a median follow-up of 1.48 years, a total of 332 prostate cancer patients were included. In the total population, the tdAUC of tPSA and fPSA/tPSA screening for prostate cancer were 0.852 and 0.748, respectively, with the optimal cut-off values of 5.08 ng/ml and 0.173, respectively. After age stratification, the age specific cut-off values of tPSA in the <60, 60-<70, and ≥70 age groups were 3.13, 4.82, and 11.54 ng/ml, respectively, while the age-specific cut-off values of fPSA/tPSA were 0.153, 0.135, and 0.130, respectively. Under the age-specific cut-off values, the sensitivities of tPSA screening for prostate cancer in males <60, 60-70, and ≥70 years old were 92.3%, 82.0%, and 77.6%, respectively, while the specificities were 84.7%, 81.3%, and 75.4%, respectively. The age-specific sensitivities of fPSA/tPSA for screening prostate cancer were 74.4%, 53.3%, and 55.9%, respectively, while the specificities were 83.8%, 83.7%, and 83.7%, respectively. Both bootstrap's internal validation and PLCO external validation provided similar results. The combination of tPSA and fPSA/tPSA could further improve the accuracy of screening.Conclusion:To improve the screening effects, it is recommended that age-specific cut-off values of tPSA and fPSA/tPSA should be used to screen for prostate cancer in the general risk population.

Objective:To determine the total and age-specific cut-off values of total prostate specific antigen (tPSA) and the ratio of free PSA divided total PSA (fPSA/tPSA) for screening prostate cancer in China.Methods:Based on the Chinese Colorectal, Breast, Lung, Liver, and Stomach cancer Screening Trial (C-BLAST) and the Tianjin Common Cancer Case Cohort (TJ4C), males who were not diagnosed with any cancers at baseline since 2017 and received both tPSA and fPSA testes were selected. Based on Cox regression, the overall and age-specific (＜60, 60-＜70, and ≥70 years) accuracy and optimal cut-off values of tPSA and fPSA/tPSA ratio for screening prostate cancer were evaluated with time-dependent receiver operating characteristic curve (tdROC) and area under curve (AUC). Bootstrap resampling was used to internally validate the stability of the optimal cut-off value, and the PLCO study was used to externally validate the accuracy under different cut-off values.Results:A total of 5 180 participants were included in the study, and after a median follow-up of 1.48 years, a total of 332 prostate cancer patients were included. In the total population, the tdAUC of tPSA and fPSA/tPSA screening for prostate cancer were 0.852 and 0.748, respectively, with the optimal cut-off values of 5.08 ng/ml and 0.173, respectively. After age stratification, the age specific cut-off values of tPSA in the <60, 60-<70, and ≥70 age groups were 3.13, 4.82, and 11.54 ng/ml, respectively, while the age-specific cut-off values of fPSA/tPSA were 0.153, 0.135, and 0.130, respectively. Under the age-specific cut-off values, the sensitivities of tPSA screening for prostate cancer in males <60, 60-70, and ≥70 years old were 92.3%, 82.0%, and 77.6%, respectively, while the specificities were 84.7%, 81.3%, and 75.4%, respectively. The age-specific sensitivities of fPSA/tPSA for screening prostate cancer were 74.4%, 53.3%, and 55.9%, respectively, while the specificities were 83.8%, 83.7%, and 83.7%, respectively. Both bootstrap's internal validation and PLCO external validation provided similar results. The combination of tPSA and fPSA/tPSA could further improve the accuracy of screening.Conclusion:To improve the screening effects, it is recommended that age-specific cut-off values of tPSA and fPSA/tPSA should be used to screen for prostate cancer in the general risk population.

Objective:To investigate the clinical and electroencephalogram (EEG) characteristics of pattern-sensitive epilepsy (PSE).Methods:This retrospective case summary study enrolled 4 pediatric patients with PSE treated at the Peking University People′s Hospital from January 2015 to September 2023.The clinical data, EEG findings, treatments, and prognosis were retrospectively analyzed.Results:Among the 4 patients, 3 were female, and 2 had developmental delays before the onset of the disease.Spontaneous seizures occurred in 3 cases, including spasticity and tonic seizures in case 1, atypical absence seizures, myoclonic seizures, and general tonic-clonic seizures in case 3, and eyelid myoclonic seizures in case 4.All 4 cases exhibited pattern-induced reflex seizures, and pattern-induced seizures with photosensitivity were monitored by EEG in 3 cases.Of the 3 cases, 1 had myoclonic seizures, 1 had eyelid myoclonic seizures, and 1 had both myoclonic seizures and focal to bilateral tonic-clonic seizures.Two out of the 4 patients were diagnosed with epilepsy syndromes: Lennox-Gastaut syndrome and epilepsy with eyelid myoclonia.All 4 patients had interictal discharges, including 2 cases of generalized discharges, 1 case of multifocal discharges combined with generalized discharges, and 1 case of anterior head discharges.Three cases underwent the detection of whole exon gene and copy number variation, and 1 case showed a novel heterozygous mutation c. 73T>C(p.W25R) in the MBD5 gene on chromosome 2.Three patients were treated with antiseizure medication (ASM), while 1 did not receive ASM treatment because the seizures were all induced.However, none of the 4 had seizures under control after 5 to 10 years of follow-up. Conclusions:PSE is more common in female children and may co-occur with developmental delays and intellectual disabilities.In PSE children, the EEG shows mostly generalized discharges, spontaneous seizures, induced seizures, and predominantly generalized seizures coexist.Reflex seizures in PSE patients are more difficult to control with ASM treatment.

Objective To evaluate the accuracy,sensitivity,specificity and economy of HLA-B*5801 gene polymorphisms detection in predicting allopurinol-related severe drug eruption before receiving allopurinol treatment using rapid health technology assessment(rHTA),to provide clinicians and policymakers with an efficient and convenient evidence-based basis.Methods PubMed,Cochrane Library,Web of Science,Embase,WanFang Data,CNKI databases and the official website of health technology assessment(HTA)agency were electronically searched to collect HTA reports,systematic reviews/Meta-analyses and pharmacoeconomic literature on the HLA-B*5801 gene polymorphisms detection from inception to December 31,2023.Two reviewers independently screened studies,extracted data,assessed the included studies'quality,and analyzed and summarised the results.Results A total of 16 literature were included,of which 5 systematic reviews/Meta-analyses and 11 pharmacoeconomic studies.The results showed that the HLA-B*5801 gene mutation rate was significantly higher in patients presenting with severe drug eruption than in the allopurinol-tolerant group(P＜0.05).Two studies reported the sensitivity and specificity of the HLA-B*5801 gene polymorphisms assay for predicting severe drug eruption,the sensitivity of 0.78,0.93,and specificity of 0.96,0.89,respectively.The economic study showed that HLA-B*5801 gene polymorphisms detection before allopurinol treatment was cost-effective in Chinese Han,Korean,Thai populations,but not in British,American(Caucasian or Hispanic),Singaporean and Malaysian populations.Conclusion HLA-B*5801 gene polymorphisms detection before allopurinol treatment and guiding drug use according to the screening results in Chinese Han population can reduce the risk of severe drug eruption and treatment costs.

Background and purpose:At present,there have been many reports on the study of methylation in cervical lesions,however it is still not clinically practical as a diagnostic and shunting index of cervical lesions.In this study,we intended to investigate the early diagnostic value of FAM19A4,PAX1 and miRNA124-2 methylation in promoter region in the progression of cervical lesions.Methods:A total of 129 liquid-based cytology specimens of different grades of cervical lesions diagnosed in the Third Affiliated Hospital of Zhengzhou University from Mar.2020 to Mar.2022.Methylation specific PCR(MSP)was used to detect the methylation changes of FAM19A4,PAX1 and miRNA124-2 genes in different cervical lesions.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of methylation changes of the three genes in cervical lesions.This study was approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University(No.2023-135-01).Results:All the specimens were collected and divided into 4 groups according to the histological results:42 cases of no intraepithelial lesions or malignant lesions(NILM),28 cases of low grade squamous intraepithelial lesion(LSIL),36 cases of high grade squamous intraepithelial lesion(HSIL),23 cases of squamous cervical cancer(SCC).With the increase in the level of cervical lesions,FAM19A4,PAX1 and miRNA124-2 gene methylation detection rates increased gradually,and the differences were statistically significant(P＜0.05).The methylation detection rates of FAM19A4,PAX1 and miRNA124-2 in HSIL group were 81.2%,80.5%and 71.8%,respectively,and the methylation detection rates of three genes in SCC group were up to 100.0%.Cytological diagnosis of cervical cancer showed the area under curve(AUC)was 0.731,with a sensitivity and a specificity of 65.9%and 80.4%,respectively.When FAM19A4,PAX1 and miRNA124-2 were used alone to diagnose HSIL+(HSIL and SCC),PAX1 methylation had the highest diagnostic efficiency,and the AUC was 0.925,with a sensitivity and a specificity of 92.8%and 87.3%.When the diagnosis was made in pairs,the AUC of FAM19A4 combined with PAX1 in the diagnosis of HSIL+was 0.930,with a sensitivity and a specificity of 95.7%and 87.1%,respectively.The AUC of FAM19A4 combined with miRNA124-2 in the diagnosis of HSIL+was 0.895,with a sensitivity and a specificity of 97.6%and 85.7%,respectively.The AUC of PAX1 combined with miRNA124-2 in the diagnosis of HSIL+was 0.928,with a sensitivity and a specificity of 95.7%and 89.1%,respectively.When the PAX1 and FAM19A4 combined with miRNA124-2 in the diagnosis of HSIL+,the AUC was 0.928,with a sensitivity and a specificity of 100.0%and 81.8%,respectively.Conclusion:The methylation of the promoter regions of the FAM19A4,PAX1 and miRNA124-2 genes demonstrates high sensitivity and specificity in diagnosing cervical lesions,indicating the potential for becoming novel indicators for early diagnosis of cervical lesions.

ObjectiveTo investigate the effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke. MethodsFrom January, 2021 to June, 2022, 52 patients with stroke in the Second Hospital of Jiaxing were enrolled and randomized into control group (n = 26) and experimental group (n = 26). Both groups received routine treatment. The control group added conventional bilateral upper limb training, while the experimental group added robot-assisted bilateral task-oriented upper limb training, for six weeks. Before and after treatment, the upper limb motor function and activities of daily living were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel Index (MBI). The upper limb proprioception test system was used to measure the average trace error (ATE) and test execution time of the upper limb. ResultsBefore treatment, there was no significant difference in the scores of FMA-UE and MBI, and ATE and test execution time between two groups (P > 0.05). After treatment, all the indexes improved significantly in both groups (|t| > 5.400, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.123, P < 0.05). ConclusionRobot-assisted bilateral task-oriented upper limb training could facilitate to improve the upper limb motor function and activities of daily living of stroke patients.

Objective:To investigate the prognosis of childhood adrenoleukodystrophy (ALD) with cognitive disorder after haploidentical allogenic hematopoietic stem cell transplantation (haplo-HSCT), and to identify risk factors affecting the prognosis.Methods:It was a single-center retrospective study involving 31 ALD children receiving haplo-HSCT in Peking University People′s Hospital from January 2014 to October 2022.Survival analysis was performed by Kaplan-Meier method. Cox regression analysis was performed to identify risk factors for the prognosis of childhood ALD following haplo-HSCT. Results:Among the 31 children with ALD, 1 case died of cardiogenic shock during the transplantation, and the remaining had a successful haplo-HSCT.Ten children with ALD had cognitive disorder before haplo-HSCT, including 3 cases with the minimal LOES score ≥10 points and 8 cases with the Neurologic Function Score (NFS)>0 point before haplo-HSCT.Six children had major functional disability (MFD) and 2 cases died due to progression of ALD after haplo-HSCT.Twenty children did not have cognitive disorder before haplo-HSCT, of whom 3 cases had the LOES score≥10 points and 6 cases had NFS>0 before haplo-HSCT.Four children had MFD and 2 cases died due to progression of ALD after haplo-HSCT.For ALD patients without cognitive disorder after haplo-HSCT, the 3-year and 5-year survival rate were 100.0% and 72.9%, respectively, and the 5-year MFD-free survival was 61.6%.For ALD patients with cognitive disorder after haplo-HSCT, the 3-year survival rate was 83.3%.Compared with ALD patients with the LOES score<10 points before haplo-HSCT, those with the LOES score≥10 points had 9.243 times the risk of developing MFD after haplo-HSCT ( P=0.024, 95% CI: 1.332-64.127). Compared with ALD patients without cognitive disorder before haplo-HSCT, ALD patients with cognitive disorder had 9.749 times the risk of developing MFD after haplo-HSCT ( P=0.023, 95% CI: 1.358-66.148). Conclusions:Cognitive disorder and LOES score≥10 points before haplo-HSCT are risk factors for developing MFD in children with ALD following haplo-HSCT.

Objective:To investigate the influence of DTAS gene mutations (DNMT3A, TET2, ASXL1, SRSF2) on survival of newly diagnosed acute myeloid leukemia (AML) patients.Methods:A retrospective analysis of 163 patients with next-generation sequencing(NGS)data in the hematology Department of Affiliated Hospital of Xuzhou Medical University from January 1, 2018 to October 31, 2021 was performed. Clinical data of patients were collected and analyzed including patient′s height, weight, gender, age, bone marrowblast ratio, induction chemotherapy regimen, transplantation or not, complete blood count, etc. There were 88 males and 75 females with a median age of 48 (4-81) years. According to the next-generation sequencing data, patients with any mutation of the above four genes were divided into the DTAS gene mutation group, and vice versa, they were divides into non-DTAS gene mutation group.The Kaplan-Meier method and Cox proportional risk model were used to analyze survival and prognosis.Results:Among 163 patients, DTAS gene mutation was detected in 50 patients (30.7%), and not in 113patients(69.3%). Among the 50 patients with DTAS genemutations, 8 cases(16%) had≥2 mutations and 42 cases(84%) had any gene mutation in DTAS. In the DTAS gene mutation group, the patients were older, the stratification of the European leukemia network(ELN) was poor, the duration of remission was shorter, the proportion of sever myelosuppression degree was higher (61.8% vs 34.8%) at day28 after induction chemotherapy, and the lymphocyte-monocyte ratio was lower than that of the healthy control group when CR was reached after treatment.The results of K-M survival analysis showed that the overall survival(OS)time ( P=0.003) and event-free survival(EFS) ( P=0.008) time of the DTAS gene mutant were significantly shorter than those of the non-DTAS gene mutated group.The medianOS timein theh DTAS gene mutations was significantly shorter than that in the non-DTAS gene mutated group ( P=0.003, HR=2.041) [21(95% CI 16.63-25.37) months vs 43 (95% CI 33.01-52.99) months].The results of multivariate COX analysis revealed that DTAS gene mutations was an independent risk facror forOS time(HR=2.041, 95% CI: 1.285-3.244, P=0.003) in AML patients. Conclusion:DTAS gene mutation does not affect the hematopoietic recovery time after induction chemotherapy, but the duration of remission is shorter in the DTAS gene mutations group. DTAS gene mutations indicate a poor prognosis, which is an independent risk factor for OS.

Objective:To explore the effect of a pelvis-assisting rehabilitation robot on lower limb function and knee proprioception after cerebral infarction.Methods:Forty hemiplegic cerebral infarction survivors were randomly divided into an experimental group and a control group, each of 20. Both groups were given routine neurological medication and rehabilitation training, while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily, five times a week for four weeks. Before and after the intervention, motor function, balance, walking function and knee joint proprioception were assessed using the simplified Fugl-Meyer lower limb assessment, the Berg balance scale, functional ambulation categorization and the Humac Norm isokinetic tester.Results:After the treatment, significant improvement was observed in all of the above measurements in both groups, but the improvements were significantly greater in the experimental group.Conclusions:Robotic pelvic assistance can effectively improve lower limb motor function, balance, knee proprioception and walking after cerebral infarction.

Objective:To investigate the effect of situational simulation drill in nurses training on prevention and treatment of venous thromboembolism (VTE).Methods:Totally 120 nurses in 1-3 years from a tertiary general hospital were selected to participate in the training for prevention and treatment of venous thromboembolism. They were divided into intervention group and control group according to the number of single and double packet ward. A total of 62 nurses in the single wards were selected as the intervention group, and a total of 58 nurses in the double wards were selected as the control group. The control group and the intervention group were trained on the prevention and treatment of venous thromboembolism by traditional teaching method and scenario simulation drill, and the effect was evaluated by Kirkpatrick Model.Results:After training, intervention group training object theory examination score, operation assessment score, clinical nursing work assessment score, and nurses ability to scale score (83.79±6.85), (87.00±4.57), (7.90±0.62), (79.03±8.24) respectively, were higher than the control group (80.67±7.90), (84.02±4.70), (7.21±0.72), (70.86±11.59), the score comparison difference was statistically significant ( t values were -3.660-5.670, P < 0.05); The satisfaction of the training object to the teaching plan, teaching content and teaching form in the intervention group was 88.71% (55/62), 87.10% (54/62) and 87.10% (54/62), which were all higher than the control group 74.14% (43/58), 72.41% (42/58) and 68.97% (40/58), with statistically significant differences ( χ2 values were 4.250, 4.038, 5.804, P<0.05). Conclusion:The application of situational simulation drill in the nursing training of prevention and treatment of VTE is helpful to improve the theoretical skills and clinical work ability of nurses in the prevention and treatment of VTE, and to increase the satisfaction of nurses with the training.