Based on the interactive ritual chain theory， this paper deeply analyzed the interactive characteristics between doctors， patients， and their families in the palliative care environment， as well as explored the role of emotional resonance， symbolic representation， and situational creation in psychological support. It also sorted out four primary issues currently present in psychological support for palliative care patients， including insufficient recognition of caregivers regarding patients’ psychological needs， limited psychological intervention methods， inadequate psychological support capabilities among medical staff， and an imperfect family and social support system. On this basis， a five-dimensional psychological support mechanism was constructed， encompassing emotional resonance， situational creation， team collaboration， environment building， and technological application. This aimed to provide palliative care patients with comprehensive and continuous psychological intervention by optimizing doctor-patient interaction， strengthening emotional connection， improving physical environment， and utilizing information technology， thereby contributing to alleviating the psychological distress patients confront in the terminal stage and improving their life dignity and quality of life.

Objective To analyze the correlation between the duration of hyperbaric oxygen(HBO)therapy and oral medication clonazepam reduction in patients with paroxysmal sympathetic hyperactivity(PSH).Methods Clinical data of patients with secondary PSH after severe brain injury at Capital Medical University Affiliated Fuxing Hospital from September 2017 to July 2023 were retrospectively included,covering general information,etiology,lesion location,comorbidities,vital signs at admission,PSH attack characteristics,HBO treatment frequency,PSH treatment drugs and dosage.According to the number of HBO treatments,PSHpatients were divided into HBO short course group(10 treatments)and HBO long course group(＞10 treatments).Multiple logistic regression and rank correlation analysis were used to investigate the correla-tion between the duration/frequency of HBO treatment and the reduction of clonazepam.Results A total of 75 PSH patients who met the inclusion and exclusion criteria were selected,including 38 cases(50.7％)who re-ceived reduced doses of clonazepam.There were 32 cases(42.7％)in the HBO short course group and 43 ca-ses(52.3％)in the HBO long course group.The reduction rate of clonazepam in the HBO short course group was lower than that in the HBO long course group[31.3％(10/32)vs.65.1％(28/43),crude OR=4.11(95％CI:1.55-10.90),P=0.004].After adjusting for confounding variables,a multivariate Logistic re-gression model showed a significant correlation between HBO long course and clonazepam reduction(OR=3.76,95％CI:1.23-11.55,P=0.021).Rank correlation analysis showed a positive correlation between HBO treatment frequency and clonazepam reduction(rs=0.331,P=0.004).Conclusions Long course HBO treatment was positively correlated with oral reduction of clonazepam in PSH patients,which may help re-duce the side effects caused by clonazepam and become a non-pharmacological treatment option for PSH.

Objective:To explore the clinical and genetic characteristics of two children with mental retardation and microcephaly.Methods:Two children who had visited the Anhui Children′s Hospital respectively on March 12 and June 22, 2021 were selected as the study subjects. Peripheral venous blood samples were collected from them and their parents, and subjected to chromosomal karyotyping and whole exome sequencing analyses. Candidate variants were verified by Sanger sequencing and pathogenicity analysis. This study was approved by the Anhui Children′s Hospital (Ethics No. EYLL-2018-008).Results:Chromosomal karyotyping and copy number detection of the two children had found no abnormality. Whole exome sequencing revealed that child 1 has harbored a c. 471delT (p.Pro157Profs*9) frameshifting variant of the CASK gene, whilst child 2 has harbored a c. 1259_1269delCTGAGAATAAC (p.Pro420fs*27) frameshifting variant of the CASK gene. Sanger sequencing confirmed that both variants were de novo in origin. Based on the guidelines from the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP), both variants were rated as pathogenic (PVS1+ PS2+ PP3). Conclusion:The de novo variants of the CASK gene probably underlay the pathogenesis of mental retardation and microcephaly in both children.

OBJECTIVE To investigate the effects of Codonopsis pilosula polysaccharide （CPP） regulating the nuclear factor- erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway on gastric mucosal injury in rats with chronic atrophic gastritis （CAG）. METHODS Rats were randomly divided into control group， model group， CPP low-dose， medium-dose and high-dose groups （CPP 10， 20， 40 mg/kg）， and ML385 group （Nrf2 inhibitor ML385 30 mg/kg+CPP 40 mg/kg）， 10 rats per group. CAG rat model was established using N-methyl-N′- nitro-N-nitrosoguanidine combined with irregular diet， then they were given drugs for consecutive 6 weeks. HE staining was used to observe the pathological changes in gastric tissue morphology； the levels of serum gastrin （GAS）， motilin （MTL）， pepsin （PP）， as well as tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8） malondialdehyde （MDA） and superoxide dismutase （SOD） in gastric mucosal tissue were detected； TUNEL assay was used to observe gastric mucosal tissue cell apoptosis； immunohistochemical assay was adopted to observe the expressions of Nrf2 and recombinant Bcl2 associated X protein （Bax） in gastric mucosal tissue； Western blot was used to detect the expressions of Nrf2， HO-1， Bax and Bcl-2 proteins in gastric mucosal tissue. RESULTS Compared with the control group， the gastric mucosal tissue was damaged； the levels of GAS， MTL， PP and SOD， and the protein expressions of Nrf2， HO-1 and Bcl-2 were significantly reduced in model group （P＜0.05）， while the levels of MDA， TNF-α and IL-8， the cell apoptosis index， and the protein expression of Bax were significantly increased （P＜0.05）. Compared with model group， CPP low-dose， medium-dose and high- dose groups showed varying degrees of improvement in gastric mucosal histopathology； the levels of the quantitative indicators were significantly reversed （P＜0.05）. Nrf2 inhibitor ML385 significantly attenuated the improvement effect of high-dose CPP on the above indicators in CAG rats （P＜0.05）. CONCLUSIONS CPP can improve gastric mucosal injury in CAG rats， and inhibit oxidative stress， inflammatory response， and cell apoptosis. The mechanism of action may be related to the activation of Nrf2/HO-1 signaling pathway.

Objective:To investigate the prevalence and related influencing factors of thyroid nodules in different occupational groups in Shijiazhuang City.Methods:Different occupational groups who underwent physical examination at the Second Hospital of Shijiazhuang City from May to December 2015 and had lived there for more than 10 years were selected as the investigation subjects, including workers, farmers, science and technology education personnel, medical and health personnel, civil servants and individual businessmen. Questionnaire survey and thyroid examination were conducted, blood lipid, blood glucose and thyroid hormone levels were tested, and related influencing factors of thyroid nodules were analyzed.Results:A total of 1 440 different occupational subjects were surveyed, and the prevalence of thyroid nodules was 20.35% (293/1 440). The prevalence of thyroid nodules in females (22.59%, 159/704) was significantly higher than that in males (18.21%, 134/736), and the difference was statistically significant (χ 2 = 4.26, P = 0.039). There was a statistically significant difference in the prevalence of thyroid nodules in different age groups (χ 2 = 73.87, P < 0.001), with the highest prevalence in the 70 - 80 age group (43.75%, 21/48). There was a statistically significant difference in the prevalence of thyroid nodules among different occupational groups (χ 2 = 36.56, P < 0.001), with the highest prevalence in individual businessmen (31.84%, 78/245). By univariate analysis, the prevalence of thyroid nodules in people with good economic status [27.45% (42/153) vs 19.48% (248/1 273)], radiation exposure history [26.39% (109/413) vs 17.92% (184/1 027)], and diabetes history [33.71% (30/89) vs 19.47% (263/1 351)] was higher (χ 2 = 5.35, 13.06, 10.45, P < 0.05). Conclusions:The prevalence of thyroid nodules in occupational group in Shijiazhuang City is relatively high, and the prevalence of thyroid nodules in females is significantly higher than that in males. Economic status, radiation exposure history and diabetes history are the main influencing factors.

To analyze the correlation between the duration of hyperbaric oxygen (HBO) therapy and oral medication clonazepam reduction in patients with paroxysmal sympathetic hyperactivity (PSH).

Progressive myoclonic epilepsies (PMEs) are a group of rare genetic diseases. Common clinical manifestations include action myoclonus often with generalized tonic-clonic seizures, cognitive impairment and other focal neurological deficits. PMEs generally respond poorly to antiseizure drugs and have a poor overall prognosis. Disorders that can cause PMEs include Unverricht-Lundborg disease, Lafora disease, neuronal ceroid lipofuscinosis, myoclonic epilepsy with fragmented red fiber syndrome, sialic acidosis, dentate erythronucleus pallidus Lewy body atrophy, etc. The current treatments for PMEs include drug therapy, neuromodulatory therapy, dietary therapy, anti-inflammatory and immunomodulatory therapy, enzyme replacement therapy and gene therapy. This article reviews the currently known treatments for PMEs, and provides ideas for better research and exploration of treatments for PMEs.

Objective:To explore the predictive value of serum 25-hydroxyvitamin D [25 (OH) D] and interleukin-6 (IL-6) levels in the development of osteoporosis (OP) in gestational diabetes mellitus (GDM) during early pregnancy.Methods:A total of 178 pregnant women with GDM admitted to Shanxi Provincial Children’s Hospital from Sep. 2018 to May. 2022 were selected as the research subjects and divided into OP group and non-OP group based on bone density. General information of patients was collected, and biochemical indicators related to bone metabolism were measured, including calcium (Ca), β-collagen special sequence ( β-CTX), type 1 procollagen amino-terminal peptide (PINP), n-terminal bone calciuim (N-MID), osteocalcin (OC), and bone alkaline phosphatase (BAP). The levels of 25 (OH) D and IL-6 in the serum of the two groups were measured. The predictive value of 25 (OH) D and IL-6 levels for GDM complicated with OP was analyzed. Results:Compared with the non-OP group (29.95±6.88), the serum 25 (OH) D level was significantly lower in the OP group (20.78±6.02) ( t=5.56, P<0.001), and the IL-6 level was significantly higher in the OP group (75.19±9.15) than in the non-OP group (50.23±10.08) ( t=10.26, P<0.001). There was no significant difference in the levels of Ca, P, β-CTX, PINP, or N-MID between the two groups (all P>0.05). The levels of BAP (13.25±3.12) and OC (6.62±1.24) in the OP group were significantly lower than those in the non-OP group (BAP: 18.23±3.78, t=5.52, P<0.001; OC: 8.75±1.52, t=5.87, P<0.001). Pearson correlation analysis showed a positive correlation between 25 (OH) D level and bone density, BAP, and OC ( r=0.26, 0.21, 0.23, all P<0.05), while IL-6 level showed a negative correlation with bone density, BAP, and OC ( r=-0.39, -0.21, -0.27, all P<0.05). ROC curve analysis showed that serum 25 (OH) D and IL-6 could serve as effective diagnostic markers for GDM complicated with OP (AUC=0.853, P<0.0001; AUC=0.869, P<0.0001) during early pregnancy. Conclusions:The serum 25 (OH) D level is decreased and IL-6 level is increased in GDM patients with OP during early pregnancy. The levels of serum 25 (OH) D and IL-6 have predictive value for the development of GDM complicated with OP during early pregnancy.

Objective:To investigate the effect of volatile organic compounds (VOCs) exposure in the atmosphere on the risk of daily death from stroke in Guangzhou.Methods:Daily average concentrations of twelve atmospheric VOCs, meteorological factors, and daily deaths for stroke and its subtypes (including ischemic and hemorrhagic stroke) in Guangzhou from 2020 to 2021 were collected. The time-series Poisson generalized additive model was established to analyze the relationship between daily average concentrations of atmospheric VOCs and daily mortality from a stroke on different lag days. The season, gender, and age group further performed stratification analysis.Results:Toluene and n-pentane were associated with a higher mortality risk from stroke and its subtypes. For each interquartile range ( IQR) increment in toluene concentration at lag0- 1 days, the RRs for mortality from stroke and hemorrhagic stroke were 1.060 (95% CI: 1.036-1.085) and 1.071 (95% CI: 1.030-1.113), respectively. For each IQR increment in n-pentane concentration, the RR for mortality from ischemic stroke was 1.064 (95% CI: 1.030-1.099). The effect estimates of VOCs may be higher during the cold season and among women and people aged ≥75 years. For each IQR increment in toluene concentration, the RRs for mortality risk of stroke in the cold season and women were 1.099 (95% CI: 1.056-1.143) and 1.085 (95% CI: 1.050-1.120), respectively. For n-pentane, the RR for death risk of stroke in people aged ≥75 years old was 1.072 (95% CI: 1.036-1.109). Results of sensitivity analysis showed that the effect estimates fluctuated less when PM 2.5 and O 3 were separately introduced for the two-pollutant model, as well as changing the degrees of freedom for covariates. Conclusions:This study suggests that VOCs may be an independent risk factor for daily mortality from stroke. Moreover, Toluene presented the most significant health impact.

Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.