Objective:To investigate the clinicopathological and genetic features of infantile rhabdomyofibrosarcoma (IRFS) with EGFR kinase domain duplication (EGFR-KDD).Methods:The clinical, morphological and immunohistochemical features of three IRFS with EGFR-KDD diagnosed from January 2022 to January 2024 at Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed using PCR or next generation sequencing technique; and related literature was reviewed.Results:There were 1 male and 2 females, aged at presentation ranging from 1 to 4 years. The tumor occurred in the left thigh, right maxillofacial region, and right popliteal space. The presenting symptom was a painless mass which was accidentally discovered. The maximum diameter of tumors ranged from 3 to 5 cm. Microscopically, the tumors were poorly defined and composed of relatively monomorphic spindle cells, arranged in diffuse, fascicular growth patterns, with moderate pale eosinophilic cytoplasm. Mitoses were abundant. A few round rhabdomyoblastic tumor cells with abundant eosinophilic cytoplasm were found. There was no evidence of hemorrhage or necrosis. The tumor cells expressed vimentin, SMA, MSA, desmin, MyoD1 and myogenin; and the Ki-67 proliferation index was 10%-60%. RT-PCR showed EGFR-KDD in all three cases. Gene fusion was detected in three cases based on next generation sequencing, but only one case had EGFR-KDD. Follow-up data for 12 to 36 months showed two patients died of the disease and one patient was alive without recurrences and metastasis.Conclusions:IRFS is a rare soft tissue tumor that resembles infantile fibrosarcoma but has immunohistochemical evidence of rhabdomyoblastic differentiation. It more commonly occurs in infants and tends to appear in limbs and torso with poor prognosis. Aggressive multimodality treatment is recommended for these patients. EGFR-KDD may be a genetic driver to IRFS. Clinical response to EGFR targeted therapy might be promising in the future.

Objective:To investigate the clinicopathological and genetic features of infantile rhabdomyofibrosarcoma (IRFS) with EGFR kinase domain duplication (EGFR-KDD).Methods:The clinical, morphological and immunohistochemical features of three IRFS with EGFR-KDD diagnosed from January 2022 to January 2024 at Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed using PCR or next generation sequencing technique; and related literature was reviewed.Results:There were 1 male and 2 females, aged at presentation ranging from 1 to 4 years. The tumor occurred in the left thigh, right maxillofacial region, and right popliteal space. The presenting symptom was a painless mass which was accidentally discovered. The maximum diameter of tumors ranged from 3 to 5 cm. Microscopically, the tumors were poorly defined and composed of relatively monomorphic spindle cells, arranged in diffuse, fascicular growth patterns, with moderate pale eosinophilic cytoplasm. Mitoses were abundant. A few round rhabdomyoblastic tumor cells with abundant eosinophilic cytoplasm were found. There was no evidence of hemorrhage or necrosis. The tumor cells expressed vimentin, SMA, MSA, desmin, MyoD1 and myogenin; and the Ki-67 proliferation index was 10%-60%. RT-PCR showed EGFR-KDD in all three cases. Gene fusion was detected in three cases based on next generation sequencing, but only one case had EGFR-KDD. Follow-up data for 12 to 36 months showed two patients died of the disease and one patient was alive without recurrences and metastasis.Conclusions:IRFS is a rare soft tissue tumor that resembles infantile fibrosarcoma but has immunohistochemical evidence of rhabdomyoblastic differentiation. It more commonly occurs in infants and tends to appear in limbs and torso with poor prognosis. Aggressive multimodality treatment is recommended for these patients. EGFR-KDD may be a genetic driver to IRFS. Clinical response to EGFR targeted therapy might be promising in the future.

Objective To identify the characteristics and research status of symptom clusters in patients with lung cancer patients during chemotherapy.Methods This scoping review was conducted under the Joanna Briggs Institute guidelines.A literature search was performed in the PubMed,Embase,CINAHL,Web of Science,Scopus,CNKI,Wanfang,and CBM databases to identify relevant studies about symptom clusters in patients with lung cancer from inception until December 31,2023.The included studies were summarized and analyzed.Results 19 papers were included and 22 symptom clusters were extracted,mainly including psychological,gastrointestinal,lung cancer-specific,fatigue-related,and respiratory symptom clusters.There are 6 symptom cluster assessment tools,of which 4 were M.D Anderson Symptom Inventory in different version;the symptom clusters were dynamically changing during chemotherapy in patients with lung cancer,with variations in core symptom clusters at different stages.Conclusion Multiple symptom clusters exist during chemotherapy in lung cancer patients,and the naming of symptom clusters and attribution of symptoms need to be further standardized.The assessment tools for symptom clusters in patients undergoing chemotherapy for lung cancer are mainly based on the Anderson Symptom Assessment Scale and other language versions.Symptom clusters in patients with lung cancer during chemotherapy show dynamic changes,and there are differences in core symptom groups at different stages.

Objective To explore relationship between the nature of carotid atherosclerotic plaque and the number and function of endothelial progenitor cells in peripheral blood.Methods A prospective study of 80 carotid atherosclerotic plaque patients were selected from June 2016 to March 2017 in Guangdong Second Provincial General Hospital.All patients were examined with Cranial magnetic resonance imaging or X-ray computed tomography,pathological examination,carotid artery color Doppler ultrasonography.Patients were divided into hard plaque group (n =42) and soft plaque group (n =38) according to the nature of carotid atherosclerotic plaque.Forty healthy subjects were selected as controls.Monocytes were obtained from 10 ml of elbow venous blood by density gradient centrifugation.Adherent cells were cultured and identified by confocal laser microscopy.The number,migration,proliferation and adhesion of EPCs in soft plaque group and hard plaque group were evaluated.Results The number of proliferating cells (0.847 ± 0.037),migrating cells(27.697±8.248) and adherent cells (46.184± 7.876) in the normal control group were significantly higher than those in the hard plaque group ((0.647±0.019),(18.643±3.289),(32.165±4.325)) and the soft plaque group ((0.679± 0.023),(23.576± 6.327),(40.587±6.523)) (all P＜ 0.001),while the proliferation,migration and adherent cells in the hard plaque group were lower than those in the soft plaque group (all P＜0.001).Conclusion The nature of carotid atherosclerosis plaque is closely related to the number and function of endothelial progenitor cells in peripheral blood.The number of endothelial progenitor cells in carotid atherosclerosis patients with hard plaque is small,and their proliferation,migration and adhesion ability are impaired.

Objective To investigate the recognition of physicians′ advice about high-alert medications among clinical nurses from grade three and first-class hospitals in Chongqing and to analyse the relevant training requirements. Methods Using a multistage stratified cluster sampling strategy, the physicians′ advice recognition questionnaire of High- alert medications for clinical nurses was administered to 3029 nurses in eight hospitals, to test the nurses′ advice recognition of high-alert medication and collecte training suggestions. Results More than 82.70％(1946/2353) of nurses responded correctly for 8 out of the 12 questions, the accuracy rate of pethidine hydrochloride injection test was 97.11％(2285/2353) and the dopamine hydrochloride injection test was only 28.56％(672/2353). The nurses′ recognition of physicians′ advice of high-alert medications in gender, department, working time and annual income was statistically significant (P<0.10). 81.34％(1914/2353) of the nurses were able to recognize 11 out of the total 24 wrong advices. Pre-job training、theoretical knowledge related to physicians′advice and case-based learning are the best training time, content and form. Conclusions The recognition level of high-alert medications by clinical nurses from grade three and first-class hospitals in Chongqing was not high and the clinical nurses with different gender, department, working time and annual income had different abilities, the targeted training for clinical nurses should be provided.

Objective To discuss the application form, method and effect of blending learning based on MOOC in Obstetrics and Gynecology Nursing Course, so as to improve learning quality and com-prehensive qualities of students. Methods Randomly selected a nursing undergraduate class as experi-mental group (n=190) and another as control group (n=189);blending learning and traditional teaching model were adopted, respectively. T test and chi-square test were used to compare scores of final exam in two groups, and Rating Scale of Self-directed Learning Competence for Nurses and Scale of Clinical Commu-nication Competence for Nursing Students were used to evaluate two groups before and after the course. Results The average score (76.30±7.08) and excellent rate (35.79％) in the experimental group were higher than those in the control group of (74.78 ±7.18) and 25.93％, with significance differences (P<0.05);Surveys showed that after the course, the autonomous learning ability and the clinical communication ability of students in the experimental group were better than before, and were better than those in the control group. Conclusion Blending learning can be applied to Obstetrics and Gynecology Nursing Course, which can effectively improve learning quality and enhance students' ability of independent study and clinical com-munication, with satisfactory teaching effects to both teachers and students.

Purpose To investigate the clinicopathologic features of desmoplastic fibroma of bone (DF).Methods The clinical and pathologic profiles of 7 cases were retrospectively analyzed.Results Desmoplastic fibroma of bone was a rare neoplasm of bone,which typically occurred in young children and adolescents.The tumor showed infiltrative and locally aggressive nature,the most common sites were long tubular bones and mandible.Microscopically,the tumor was composed of sparse fibroblasts in a rich background of collagen fibers.Immunohistochemically,the tumor cells were positive for vimentin and SMA.Conclusion Desmoplastic fibroma is a rare,locally aggressive fibroblasticlesion of bone.It can make an accurate diagnosis by integrating the clinical location with histopathological features.Trauma,hormone and horomosome aberration may be related with its pathogenesis.

Purpose To investigate the clinicopathologic features of calcifying aponeurotic fibroma (CAF). Methods The clinical and pathologic profiles of 6 cases of CAF were retrospectively analyzed. Results CAF appeared a firm, painless and slowly growing mass with a predilection for the distal portions of the extremities in young children and adolescents. Microscopically, the tumor consis-ted mainly of benign appearing spindle cells, chondroid cells and calcific debris. Immunohistochemically, the tumor cells were positive for vimentin, HHF-35, S-100, Calponin and CD68. Conclusion CAF is a rare, locally aggressive fibroblastic lesion. It can make an accurate diagnosis by integrating the clinical location with histopathological features. Repeated minor trauma to the extremities and some embryologic cell nests maybe its pathogenesis.

Objective To observe effect of using ambroxol to humidify of airway during mechanical ventilation to treat severe pneumonia in infants,and to explore dynamic changes of respiratory mechanics.Methods Sixty-five infants with severe pneumonia need ventilator treatment according the diagnosis criterion were divided into 2 groups by random digits table method:experimental group (33 cases) and control group (32 cases).Experimental group was used ambroxol and control group was used 0.9％ sodium chloride,each 2 ml intratracheal instillation,and then took the balloon pressurized oxygen 30 s,followed by ventilator,after 24 h.Changes of respiratory mechanics indexes were observed before and after treatment,including:mean airway resistance,lung dynamic compliance,work of breathing,airway plateau pressure.Respiratory mechanics values were recorded before and after treatment.Results After treatment for 24 h,the index in experimental group were better than those in control group.Mean airway resistance were (0.68 ± 0.04) cmH2O/ (L·s) and (0.57 ± 0.05) cmH2O/ (L·s),1 cmH2O =0.098 kPa,lung dynamic compliance were (3.17 ± 0.81) ml/kPa and (2.56 ± 0.69) ml/kPa,work of breathing were (0.54 ± 0.08) J/L and(0.41 ± 0.06) J/L,airway plateau pressure were (2.23 ± 0.58) cmH2O and (2.12 ± 0.63) cmH2O.There were significant differences (P ＜ 0.05).The mechanical ventilation time in experimental group was significantly shorter than that in control group [(64.08 ± 13.92) h vs.(79.57 ± 19.64) h] (P ＜0.05).Conclusion Airway humidification using ambroxol can better treat severe pneumonia,reduce airway resistance and improve alveolar ventilation,shorten time on the machine.

Objective To explore the methods and results of the application of formative assessment in gynecology and obstetrics nursing teaching.Methods In the gynecology and obstetrics nursing teaching practice,556 undergraduate students in Grade 2011 were set as experimental group while 339 students in Grade 2010 as control group.Based on the teaching syllabus,in the experimental group,traditional lecture and bilingual teaching method were applied in theory courses and PBL or PBL combined with Scene simulation were applied in practice lessons.And after the teaching,formative assessment was applied in the experimental group,which included setting up small study groups and learning files,giving evaluation to students' participation in class activities,written assignments,operation exams,attendance to classes and their in-class test results.In the evaluation of a student,the results of formative assessment took a proportion of 50％ and the final exam result took the other half.While in the control group,traditional summative assessment was applied,namely,results of the final exams were the terminal results of students.Results Gynecology and obstetrics nursing got the first prize in the Final-term Assessment of Teaching Efficiency of the Nursing School.When comparing the results of the final exam of the students in the experimental group and the control group,there was statistically difference(P=0.000),and 86％ of the students in the experimental group were in favor of formative assessment.Conclusion When applied in gynecology and obstetrics nursing teaching in undergraduate students,formative assessment can help teachers adjust teaching methods to improve the effectiveness of teaching; it can also make students more motivated in learning and help students form good learning habits and improve their learning strategies,which can improve students' comprehensive quality.