Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

Objective To develop a mental fatigue detection method for spaceflight environments in response to the mental fatigue problem that may arise during the on-orbit period of astronauts.Methods In the ground-based research,we used a 36-hour sleep deprivation experiment to induce mental fatigue state.Then the electroencephalogram(EEG)data and questionnaire scores were collected from 45 subjects.Finally,a series of EEG features relevant to mental fatigue were calculated and a mental fatigue detection method constructed with Random Forest Classifier to differentiate the mental fatigue level.Results The average accuracy over 85%was achieved in both ground-based and space-based experimental data and each evaluation index had consistent trend.Conclusion The mental fatigue detection method based on EEG signals is suited to the differences in environment and tasks,and shows precise and stable performance in both ground-based experiment and space-based one,which is feasible to be applied in spaceflight environments in the future.

Pulmonary hypertension (PH) is an extremely malignant pulmonary vascular disease of unknown etiology. ADAR1 is an RNA editing enzyme that converts adenosine in RNA to inosine, thereby affecting RNA expression. However, the role of ADAR1 in PH development remains unclear. In the present study, we investigated the biological role and molecular mechanism of ADAR1 in PH pulmonary vascular remodeling. Overexpression of ADAR1 aggravated PH progression and promoted the proliferation of pulmonary artery smooth muscle cells (PASMCs). Conversely, inhibition of ADAR1 produced opposite effects. High-throughput whole transcriptome sequencing showed that ADAR1 was an important regulator of circRNAs in PH. CircCDK17 level was significantly lowered in the serum of PH patients. The effects of ADAR1 on cell cycle progression and proliferation were mediated by circCDK17. ADAR1 affects the stability of circCDK17 by mediating A-to-I modification at the A5 and A293 sites of circCDK17 to prevent it from m1A modification. We demonstrate for the first time that ADAR1 contributes to the PH development, at least partially, through m1A modification of circCDK17 and the subsequent PASMCs proliferation. Our study provides a novel therapeutic strategy for treatment of PH and the evidence for circCDK17 as a potential novel marker for the diagnosis of this disease.

Objective:To investigate the effect of biological maternal sounds on blood gas analysis index, mechanical ventilation time, oxygen therapy time and hospital stay in mechanically ventilated children with severe pneumonia.Methods:This study was a randomized controlled trial. From June 2020 to November 2020, 128 mechanically ventilated children with severe pneumonia in Hunan Children′s Hospital were selected by convenient sampling method and divided into four groups with 32 cases in each group by random number table method. Group A was given routine nursing care, group B was given mother sounds, group C was given mother cardiotone, group D was given biological maternal sounds. Data of blood gas analysis index, mechanical ventilation duration, oxygen therapy duration, hospital stays were collected for comparative analysis.Results:Finally, group A, B, C, and D included 28, 30, 28 and 28 cases, respectively. There was no statistically significant difference in PaO 2 among the four groups on the 1st to 2nd day after intervention ( P>0.05), but PaO 2 on the 3rd to 7th day after intervention were (75.57 ± 12.88), (77.71 ± 15.81), (78.21 ± 14.51), (78.64 ± 17.71), (79.04 ± 11.57) mmHg (1 mmHg=0.133 kPa), (81.71 ± 17.89), (82.93 ± 18.36), (82.68 ± 15.47), (83.25 ± 14.24), (83.77 ± 13.90) mmHg, (80.89 ± 18.78) (82.11 ± 13.34), (82.96 ± 14.20), (83.43 ± 14.37), (83.68 ± 12.64) mmHg, (84.54 ± 18.77), (86.29 ± 10.94), (86.96 ± 10.53), (87.46 ± 12.64), (89.08 ± 12.21) mmHg, with statistically significant differences ( F values were 41.17 - 332.68, all P<0.01). Further pairwise comparison revealed that PaO 2 in group B and group C were higher than those in group A on the 3rd to 7th day after intervention, while those in group D were higher on the 3rd to 7th day after intervention than those in group A, B, and C, with statistically significant differences( t values were 3.35- 4.75, all P<0.01). There was no statistically significant difference in PaCO 2 among the four groups on the 1st to 4th day after intervention ( P>0.05), but PaCO 2 on the 5th to 7th day after intervention was (47.31 ± 2.89), (46.18 ± 2.06), (41.94 ± 2.09) mmHg, (44.73 ± 1.76), (41.38 ± 1.30), (38.33 ± 1.16) mmHg, (44.81 ± 1.24), (41.23 ± 1.89), (38.73 ± 2.55) mmHg, (40.83 ± 1.78), (37.87 ± 1.43), (34.78 ± 2.05) mmHg, with statistically significant differences ( F=29.48, 36.12, 34.52, all P<0.05). Further pairwise comparison revealed that PaCO 2 in group B and group C were lower than those in group A on the 5th to 7th day after intervention, while PaCO 2 in group D were lower than those in groups A, B, and C, with statistically significant differences ( t values were 3.37-4.85, all P<0.01). During the analysis of PaO 2 and PaCO 2 in the four groups at different time points, the interaction effects were not statistically significant ( P>0.05). There was no significant difference in invasive mechanical ventilation duration, non-invasive mechanical ventilation duration and hospital stay among the four groups after intervention ( P>0.05). The oxygen therapy time of the four groups were (8.61 ± 6.40), (6.17 ± 4.80), (6.23 ± 2.75), and (3.75 ± 2.10) days, with statistically significant differences ( F=17.27, P<0.01). Further pairwise comparison revealed that the oxygen therapy time in group B and group C was shorter than that in group A, while group D was significantly shorter than that in groups A, B, and C, with statistically significant differences ( t values were 4.02-4.74, all P<0.01). Conclusions:Biological maternal sounds is superior to maternal sound and mother cardiotone in improve the blood gas analysis index, shorten the oxygen treatment time, which is worthy of clinical promotion in neonatal unaccompanied ward.

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.

Objective:To deeply understand the real emotional experience and needs of the parents of dying newborns, so as to provide a reference for future neonatal palliative care.Methods:From February to October 2021, purposeful sampling was used to select 15 parents of dying newborns in the Department of Neonatology of Hunan Children's Hospital as the research object. A qualitative research design was conducted, and the semi-structured interview method was used to conduct in-depth interviews with the research subjects, and NVivo 10.0 software was used for data analysis.Results:A total of 3 themes were extracted, namely, the ambivalence when giving up treatment, negative life effects after giving up, needs and expectations.Conclusions:Parents of dying newborns generally have ambivalence when they give up treatment. After giving up, they will show emotions such as sadness and helplessness, self-blame and regret, and depression. Understanding the real emotions and inner needs of the parents of dying newborns helps medical and nursing staff to pay attention to parents' negative psychology and understand their needs, and provide parents with targeted psychological support and other care, so as to help the parents of dying newborns and their families through a special period.

According to the state's relevant policies on the development of hospice care, hospice care has become a social concern, and it is currently one of the key areas of medical development in China. This article elaborates on the current status and necessity of the development of children's hospice care, summarizes the application effects of family-centered child hospice care in the quality of life of children, the degree of grief of family members and the relationship between doctors and patients, and puts forward corresponding suggestions. This article aims at speeding up the standardized construction of the family-centered hospice care model in our country, and promote the development of children's hospice care in our country.

Objective:To investigate the iodine nutritional status among children aged from 8 - 10 and pregnant women in Xiamen City before and after adjustment of salt iodine concentration, and scientifically evaluate the suitability of the new standard iodized salt adjustment policy for Xiamen City.Methods:In the pre-adjustment period (2011) and the post-adjustment period (2018), cross-sectional research methods and stratified cluster sampling methods were adopted in six districts of Xiamen City. The salt samples of residents and pregnant women, urine samples of children aged from 8 - 10 and pregnant women were collected to determine the iodine level; thyroid of children aged from 8 - 10 was examined. Changes in salt iodine, urine iodine and goiter prevalence before and after adjusting iodine content of salt were compared.Results:The median of salt iodine in residents after the adjustment (23.5 mg/kg) was significantly lower than that of before (28.9 mg/kg, Z = - 10.512, P < 0.05), the median of salt iodine in pregnant women after the adjustment (23.7 mg/kg) was significantly lower than that of before (29.2 mg/kg, Z = - 12.622, P < 0.05); the consumption rate of qualified iodized salt in residents after the adjustment (95.7%, 1 196/1 250) was significantly lower than that of before (97.1%, 1 608/1 656; χ 2 = 4.250, P < 0.05); before and after adjustment of salt iodine concentration, the consumption rate of qualified iodized salt in pregnant women was 94.7% (124/131) and 95.9% (579/604), respectively. No significant difference was found when comparing the consumption rate of qualified iodized salt in pregnant women (χ 2 = 0.015, P > 0.05). There was significant difference in median urinary iodine (from 204.2 to 183.9 μg/L, detected in 652, 1 250 urine samples, respectively) of children aged 8 - 10 years ( Z = - 3.583, P < 0.05); the difference of iodine nutritional status in pregnant women before and after adjustment of salt iodine concentration(130.2, 130.8 μg/L, detected in 132, 604 urine samples, respectively) was not significant ( Z = - 1.715, P > 0.05). The thyroid goiter rate of children aged 8 - 10 years had reduced from 1.1% (14/1 239) to 0.2% (2/1 253), the difference was statistically significant (χ 2 = 9.195, P < 0.05). Conclusions:As a whole, the measure of control and prevention of iodine deficiency disorders through iodized salt is implemented well in Xiamen City. After adjustment of salt iodine concentration, the iodine status of children aged from 8 to 10 is adequate, but the pregnant women has showed iodine deficiency.

Objective This study was conducted to assess the accuracy of [18F] fiuorodeoxyglucose-positron emission tomography/computed tomography (18FDG PET-CT) in detection of pelvic nodal metastases in endometrial cancer.Methods Patients with endometrial cancer from January 2015 to June 2017 confirmed by the postoperative pathology were retrospectively analyzed.30 patients finished PET-CT before operation.The findings on histopathology were compared with 18FDG-PET/CT findings to calculate the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),and accuracy of 18FDG-PET/CT.To analyze the efficacy of maximum standardized uptake (SUVmax) and lymph node maximum standardized uptake (LN-SUVmax) of PET-CT in the diagnosis of pelvic lymph node metastasis.Resuits For detection of pelvic nodes,based on patient analysis,18FDG-PET/CT had a sensitivity of 75.0％,specificity of 88.5％,PPV of 50.0％,NPV of 95.8％ and accuracy of 86.7％.Based on a nodal region analysis,18FDG-PET/CT had a sensitivity of 83.3％,specificity of 98.3％,PPV of 55.0％,NPV of 99.6％,and accuracy of 98.3％.When maximum standardized uptake values (SUVmax) ＞ 8,area under curve (AUC) =0.64,Yonden Index =0.42.When maximum standardized uptake values of lymphonodus (LN-SUVmax) ＞ 3 (AUC =0.79,Yonden Index =0.63),the sensitivity and specificity of diagnosis of lymph node metastasis were 100％,42.31％,and 75.0％,88.5％,but without statistically significant difference.Although AUC of LN-SUVmax was higher than SUVmax of primary lesion,but the difference was not statistically significant (P ＞ 0.05).Conclusions 18 FDG-PET/CT has high specificity,NPV for detection of pelvic LN metastasis area in endometrial cancer,which can provide preoperative basis for patients with endometrial cancer to avoid lymph node resection,thereby reducing the risk of early endometrial cancer surgery and improving the quality of life after surgery.We concluded that,there were no exact cutoffs of SUVmax for the prediction of lymph node metastases,neither primary lesion,nor lymph node.There is clearly a need for multicenter,large-scale trials to find out better parameters in judging metastasis of lymphnodes.