Objective:To analyze the clinical characteristics of anti-melanoma differentiation associated gene 5 (MDA5) antibody-positive juvenile dermatomyositis (JDM) patients.Methods:A retrospective case-control study was conducted. The positive group included 18 children with anti-MDA5 antibody-positive JDM who were admitted to the Department of Rheumatology and Immunology at Capital Center for Children′s Health with Capital Medical University between January 2016 and January 2023. Another 36 children with anti-MDA5 antibody-negative JDM hospitalized during the same period were enrolled as the negative group. Based on the extent of pulmonary involvement and pulmonary CT scores, the MDA5-positive group was further divided into severe pulmonary involvement and non-severe pulmonary involvement subgroups. Chi-square test and Kruskal-Wallis test were used to compare clinical features, laboratory test results between groups.Results:Among the 18 patients in the MDA5-positive group, 7 were male and 11 were female, with an age of onset of 5.0 (2.6, 9.4) years and disease duration of 6.0 (4.0, 9.3) months. The MDA5-negative group included 36 cases (14 male, 22 female), with an age of onset of 4.9 (2.0, 7.0) years and disease duration of 5.0 (1.8, 7.0) months. The MDA5-positive group exhibited significantly higher rates of arthritis, skin ulcers, and interstitial lung disease (ILD), along with elevated serum ferritin (SF) and erythrocyte sedimentation rate levels compared to the MDA5-negative group (9/18 vs. 11% (4/36), 6/18 vs. 3% (1/36), 16/18 vs. 33% (12/36), 327 (141, 518) vs. 131 (68, 257) μg/L, 17.5 (12.5, 26.8) vs. 11.0 (5.0, 13.0) mm/1 h, χ2=7.92, 7.41, 14.84, Z=2.50, 2.87, all P<0.05). Conversely, the MDA5-positive group had lower rates of muscle weakness and lower creatine kinase levels (5/18 vs. 75% (27/36), 58.5 (49.3, 97.5) vs. 225.0 (68.0, 695.5) U/L, χ2=11.08, Z=-2.94, both P<0.05). Severe pulmonary involvement 6 cases and non-severe pulmonary involvement subgroups 12 cases. Among the MDA5-positive patients, those in the severe pulmonary involvement subgroup had an older age at onset and higher rates of muscle weakness as well as hydroxybutyrate dehydrogenase (HBDH), lactate dehydrogenase (LDH), SF, and Krebs von den Lungen-6 (KL-6) compared to the non-severe subgroup (all P<0.05). In the MDA5-positive group, 17 patients improved after treatment with glucocorticoids combined with immunosuppressants, while One died due to rapidly progressive ILD. Conclusions:Anti-MDA5 antibody-positive JDM is characterized by typical skin rashes, a high incidence of arthritis and skin ulcers, relatively mild muscle involvement, but is prone to ILD. Among MDA5-positive patients, those with older age at onset, muscle involvement (manifested as muscle weakness and elevated muscle enzymes (LDH, HBDH)), or significantly elevated KL-6 and SF levels are more likely to develop severe pulmonary complications.

Objective:Using resting-state functional magnetic resonance imaging (rs-fMRI), we explored the changes in dynamic functional network connections (dFNC) in the brains of patients with first-episode schizophrenia (SZ) and evaluated the potential clinical value of dFNC changes in combination with a machine learning model.Methods:Clinical data of 50 patients with schizophrenia (schizophrenia group), 29 males and 21 females, aged 18-47 (28.3±7.2) years, who attended the psychiatric department of the Second Affiliated Hospital of Xinxiang Medical College from January 2022 to August 2023, were retrospectively included. In the same period, 50 healthy controls matched for age and education (healthy control group) were recruited, of which 24 were male and 26 were female, aged 18-48 (28.0±6.9) years. The rs-fMRI imaging data were acquired for each subject. The dFNC cluster analysis was performed based on independent component analysis, and the differences between groups with different state FNC matrices were statistically analyzed. The dataset samples were divided into a training set (35 SZ patients and 35 healthy controls) and a validation set (15 SZ patients and 15 healthy controls) in a 7∶3 ratio. A machine learning classification model was constructed based on the dFNC matri. The performance of the model for distinguishing between schizophrenia and healthy controls was assessed by five-fold cross-validation using accuracy (ACC), recall (REC), F1 score, and area under curve (AUC) metrics of the working characteristics of the subjects.Results:Five network functional connectivity states were obtained by dFNC cluster analysis. Patients with first SZ showed a wide range of high connectivity and low connectivity changes on the neural dynamic functional networks, as shown by increased dynamic connectivity within the visual network (VIS) in state 1 (weak connectivity); The dynamic connectivity between executive control network (ECN) and VIS, frontal parietal network (FPN) and VIS decreases at state 3 (strong connectivity); The dynamic connectivity between default mode network (DMN) and FPN, DMN and ventral attention network (VAN) decreases at state 4 (weak connectivity). The machine learning results show that the classification model constructed by the dFNC matrix combined with SVM in state 3 (strongly connected) in the validation set obtains the best classification results (ACC=0.938; REC=0.938; F1=0.937; AUC=0.984), and the overall average classification ACC of the five states reaches 0.751, and AUC reaches 0.784.Conclusion:Patients with first-episode SZ have some brain functional network connectivity abnormalities, and a machine learning model based on dFNC features has high classification performance in distinguishing first-episode SZ from HC.

Objective:To analyze the clinical characteristics of anti-melanoma differentiation associated gene 5 (MDA5) antibody-positive juvenile dermatomyositis (JDM) patients.Methods:A retrospective case-control study was conducted. The positive group included 18 children with anti-MDA5 antibody-positive JDM who were admitted to the Department of Rheumatology and Immunology at Capital Center for Children′s Health with Capital Medical University between January 2016 and January 2023. Another 36 children with anti-MDA5 antibody-negative JDM hospitalized during the same period were enrolled as the negative group. Based on the extent of pulmonary involvement and pulmonary CT scores, the MDA5-positive group was further divided into severe pulmonary involvement and non-severe pulmonary involvement subgroups. Chi-square test and Kruskal-Wallis test were used to compare clinical features, laboratory test results between groups.Results:Among the 18 patients in the MDA5-positive group, 7 were male and 11 were female, with an age of onset of 5.0 (2.6, 9.4) years and disease duration of 6.0 (4.0, 9.3) months. The MDA5-negative group included 36 cases (14 male, 22 female), with an age of onset of 4.9 (2.0, 7.0) years and disease duration of 5.0 (1.8, 7.0) months. The MDA5-positive group exhibited significantly higher rates of arthritis, skin ulcers, and interstitial lung disease (ILD), along with elevated serum ferritin (SF) and erythrocyte sedimentation rate levels compared to the MDA5-negative group (9/18 vs. 11% (4/36), 6/18 vs. 3% (1/36), 16/18 vs. 33% (12/36), 327 (141, 518) vs. 131 (68, 257) μg/L, 17.5 (12.5, 26.8) vs. 11.0 (5.0, 13.0) mm/1 h, χ2=7.92, 7.41, 14.84, Z=2.50, 2.87, all P<0.05). Conversely, the MDA5-positive group had lower rates of muscle weakness and lower creatine kinase levels (5/18 vs. 75% (27/36), 58.5 (49.3, 97.5) vs. 225.0 (68.0, 695.5) U/L, χ2=11.08, Z=-2.94, both P<0.05). Severe pulmonary involvement 6 cases and non-severe pulmonary involvement subgroups 12 cases. Among the MDA5-positive patients, those in the severe pulmonary involvement subgroup had an older age at onset and higher rates of muscle weakness as well as hydroxybutyrate dehydrogenase (HBDH), lactate dehydrogenase (LDH), SF, and Krebs von den Lungen-6 (KL-6) compared to the non-severe subgroup (all P<0.05). In the MDA5-positive group, 17 patients improved after treatment with glucocorticoids combined with immunosuppressants, while One died due to rapidly progressive ILD. Conclusions:Anti-MDA5 antibody-positive JDM is characterized by typical skin rashes, a high incidence of arthritis and skin ulcers, relatively mild muscle involvement, but is prone to ILD. Among MDA5-positive patients, those with older age at onset, muscle involvement (manifested as muscle weakness and elevated muscle enzymes (LDH, HBDH)), or significantly elevated KL-6 and SF levels are more likely to develop severe pulmonary complications.

Objective:Using resting-state functional magnetic resonance imaging (rs-fMRI), we explored the changes in dynamic functional network connections (dFNC) in the brains of patients with first-episode schizophrenia (SZ) and evaluated the potential clinical value of dFNC changes in combination with a machine learning model.Methods:Clinical data of 50 patients with schizophrenia (schizophrenia group), 29 males and 21 females, aged 18-47 (28.3±7.2) years, who attended the psychiatric department of the Second Affiliated Hospital of Xinxiang Medical College from January 2022 to August 2023, were retrospectively included. In the same period, 50 healthy controls matched for age and education (healthy control group) were recruited, of which 24 were male and 26 were female, aged 18-48 (28.0±6.9) years. The rs-fMRI imaging data were acquired for each subject. The dFNC cluster analysis was performed based on independent component analysis, and the differences between groups with different state FNC matrices were statistically analyzed. The dataset samples were divided into a training set (35 SZ patients and 35 healthy controls) and a validation set (15 SZ patients and 15 healthy controls) in a 7∶3 ratio. A machine learning classification model was constructed based on the dFNC matri. The performance of the model for distinguishing between schizophrenia and healthy controls was assessed by five-fold cross-validation using accuracy (ACC), recall (REC), F1 score, and area under curve (AUC) metrics of the working characteristics of the subjects.Results:Five network functional connectivity states were obtained by dFNC cluster analysis. Patients with first SZ showed a wide range of high connectivity and low connectivity changes on the neural dynamic functional networks, as shown by increased dynamic connectivity within the visual network (VIS) in state 1 (weak connectivity); The dynamic connectivity between executive control network (ECN) and VIS, frontal parietal network (FPN) and VIS decreases at state 3 (strong connectivity); The dynamic connectivity between default mode network (DMN) and FPN, DMN and ventral attention network (VAN) decreases at state 4 (weak connectivity). The machine learning results show that the classification model constructed by the dFNC matrix combined with SVM in state 3 (strongly connected) in the validation set obtains the best classification results (ACC=0.938; REC=0.938; F1=0.937; AUC=0.984), and the overall average classification ACC of the five states reaches 0.751, and AUC reaches 0.784.Conclusion:Patients with first-episode SZ have some brain functional network connectivity abnormalities, and a machine learning model based on dFNC features has high classification performance in distinguishing first-episode SZ from HC.

Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved; 9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children; 7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.

Objective:To investigate the status quo of communication between contracted family doctor team and the disabled.Methods:Using convenience sampling, family doctor team members of 80 community health centers (CHCs) in Beijing were selected to participate in a questionnaire survey from April to June 2022. The questionnaire included the basic information of team members, the choice of communication methods and targets, the acquisition of communication knowledge and skills and so on.Results:A total of 365 team members participated in the survey. The most common type of disability was physical disability (78.08%,285/365). All participants met communication obstacles with disabled people in contracted health service, and hearing and speech disabilities were the most common (70.14%, 256/365). Only 13.42% (49/365) chose to directly communicate with the disabled themselves; 84.93% (310/365) used "increase the volume and slow down" method when communicating with the disabled, and 38.63% (141/365) chose "write and convey multiple messages at the same time". Most of participants (84.38%, 308/365) indicated the need for professional training in communication with persons with disabilities.Conclusion:There are communication obstacles between family doctor team members and the disabled during contracted services. More relevant professional training are urgently needed for contracted family doctor team to improve the abilities to communicate with the disabled.

Objective:To develop a guiding manual of family doctor contracting service for the disabled with Delphi method.Methods:From November 2017 to July 2018, a research group was formed and a survey on the status of family doctor service for disables was conducted in Beijing and other places. After the preliminary outline was formulated, 15 experts from the fields of general practice and rehabilitation for the disabled were invited and 4 rounds of expert consultation were conducted, finally the Guiding Manual of Family Doctor Contracting Service for the Disabled was developed. Results:The authority coefficient of experts was 0.870, and 13, 13, 15 and 15 questionnaires were collected from 15 experts in 4 rounds of consultation, respectively. The W value of Kendall harmony coefficient of the fourth round of expert consultation was 0.394 (χ 2=319.501, P<0.01) and accuracy was 0.234 (χ 2=189.189, P<0.01). After adding and deleting terms by the suggestion and scores of experts, the final draft of the manual is formed, including 5 first-level terms, 15 second-level terms, 18 third-level terms and 17 fourth-level terms. Conclusion:The Guiding Manual of Family Doctor Contracting Service for the Disabled has been developed with Delphi method. Its reliability, validity and practicability need to been further studied.

Objective To establish the background information of physiological parameters for germ?free ( GF ) Taihu piglets. Methods In this study we selected 25 days old GF Taihu piglets and 4 conventional ( CV) littermates, the male and female ratio was 1∶3, to measure the normal clinical values of hematology and serum biochemistry, immunoglobu?lin concentration and main organ coefficients. The analysis of relative growths of main organ weight to body weight was con?ducted in the Taihu GF and CV pigs by allometric scaling model. Results (1) Twelve hematological parameters and 8 blood biochemical parameters in the GF piglets were significantly lower than those in CV pigs (P<0?05). (2) The aver?age body weight, IgM concentration of GF pigs and CV pigs had significant difference ( P <0?05 ) , and no mesenteric lymph nodes were found in the GF pigs. (3) The gut weight had the largest allometric association with body weight in the GF pigs, while spleen weight has the largest allometric association with body weight in the CV pigs. Both the weight of heart and stomach in CV and GF pigs had a negative allometric association with body weight (allometric coefficient b<1), respectively. Conclusions Different microbe control grades affect the body weight, hematology and serum biochemistry, expression of immunoglobulin and development of main organs in laboratory pigs.

Objective:To understand the responsiveness of community health service institutions in Henan Province. Methods:This research collected information through questionnaire investigations. The object of the investigations is key informants familiar with community health service institutions. Various dimensions of responsiveness within Henan province community health service institutions are determined through a multiple-input pecking order graph. The fuzzy comprehen-sive evaluation method is used to evaluate the level of responsiveness. Responsiveness inequality index is used to measure the distribution of reactions. Results:A total of 431 valid key informants were surveyed. The various dimensions of the questionnaire of Cronbach alpha coefficient was greater than 0. 623;the total scale of the Cronbach alpha coefficient was 0. 850;the correlation coefficient of each dimension of test-retest reliability were greater than 0. 907. The levels of responsive-ness and distribution index were 8. 33 and 0. 2744, respectively;each dimension by order of importance:timely attention>dignity>infrastructure>communication>confidentiality >social support >selective >autonomy. Approximately 50% of key informants considered that vulnerable groups in community health service institutions were sometimes or often treated unfairly. Conclusion:Key informants considered the responsiveness level of overall higher community health service institu-tions in Henan Province was high, and the distribution of responsiveness was relative equilibrium. However, there is a large shortage of infrastructure, privacy protection, doctor-patient communication, etc.

Objective To evaluate the effect of ultrasound-guided vacuum-assisted minimal invasive resection(Mammotome procedure)of breast lumps through the retromammary space. Methods Seven hundred and eighty-seven patients in Obstetrics and Gynecology Hospital Affiliated to Fudan University from Jan. 2011 to May 2012 were underwent ultrasound-guided Mammotome operation through the retromammary space (retromammary space group,385 cases),or adjacent the lumps,and followed by post-operation visits regularly (Mammotome operation adjacent the lumps group,402 cases). The operation effects were compared between the two groups. Results All cases were followed up for 12 months. The period of Mmmotome operation through the retromam mary space and the rate of resection were(48 ± 6)min and(52 ± 4)min,99. 48%(383 / 385), 99. 25%(399 / 402),perspectively,in group of Mammotome operation through the retromammary space and Mammotome operation adjacent lumpsand. There was no significant difference between the two groups( P> 0. 05). The amount of procedural bleeding,the incidence of ecchymosis,local hematoma and the number of incision in group of Mammotome operation through the retromammary space were(8 ± 3)ml,2. 34%(9 / 385), 0. 52%(2 / 385),(1. 3 ± 0. 6)respectively,which were significantly lower than those in Mammotome operation adjacent the lumps group((14 ± 6)ml,8. 71%(35 / 402),2. 74%(11 / 402),(2. 4 ± 0. 3)respectively). There were statistical difference between two groups( P = 0. 003,P < 0. 001,P = 0. 001,P = 0. 006). The rate of satisfaction in group of Mammotome operation through the retro-mammary space was 98. 70%(380 / 385),which is significantly higher than in group of Mammotome operation adjacent the lumps(89. 30%(359 / 402),P< 0. 01). Conclusion The therapy approach of ultrasound-guided Mammotome operation through the retromammary space has lower hemorrhagic complication,as well as the better effect with special advantages. Therefore it has prospective clinical application.