Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective To observe the echocardiographic manifestations of infective endocarditis(IE)complicated with valve damage in children.Methods Totally 104 children with IE were retrospectively enrolled and divided into non-damage group(n=34),mild damage group(n=39)and dysfunction group(n=31)according to whether complicated with valve damage and damage's degree.The general and echocardiographic data were compared among groups,and the echocardiographic characteristics of IE complicated with valve damage in children were analyzed.Results Significant difference of the proportion of combining with other congenital heart diseases(excluding bicuspid aortic malformations),the incidence of embolization events during hospital stay,also of endocarditis of left cardiac system were found among groups(all P＜0.05).Pairwise comparison showed that in non-damage group,the proportion of combining with other congenital heart diseases was higher,while the incidence of endocarditis of left cardiac system was lower than those in both mild damage group and dysfunction group(all P＜0.05).The incidence of embolization events during hospital stay in non-damage group was lower than that in dysfunction group(P＜0.05).Among 70 cases of IE complicated with valve damage,mitral valve(30/70,42.86％)was the most common involved valve,mostly presented as valve stenosis(63/70,90.00％).No significant difference of valve involvement site,valve structural lesions nor the incidence of valve stenosis was found between mild damage group and dysfunction group(all P＞0.05).Conclusion IE complicated with valve damage in children mostly involved left cardiac system,and the risk of embolization events was higher than that of IE children without valve damage.Echocardiography could be used as an important method for evaluating the site of valve involvement and the degree of damage.

Objective To observe the manifestations of isolated bicuspid aortic valve(i-BAV)in children using echocardiography.Methods Echocardiographic data of 79 children with i-BAV were retrospectively analyzed,and classification of i-BAV was performed.The patients were divided into complication group(n=50)and non-complication group(n=29)according to the existence of valve and/or aortic involvement or not,and echocardiographic parameters were compared between groups.Results After adjusting body surface area(BSA),in complication group,left ventricular end-systolic diameter/BSA was lower,while left ventricular myocardial mass index group was higher than those in non-complication group(both P＜0.05).Type 0 i-BAV was found in 22 cases,with lat subtype as the most common ones(18/22,81.82％),while Type Ⅰ was observed in 57 cases with L-R subtype as the most common ones(39/57,68.42％).The most common subtype in complication group was also Type Ⅰ L-R(31/50,62.00％),with incidence of valve involvement of 90.00％(45/50),mainly including mild aortic stenosis and/or incompetence(37/45,82.22％),and incidence of aorta involvement of 24.00％(12/50),all with type Ⅰ or Ⅱ aortic widening.Conclusion The most common subtype of i-BAV in children was type Ⅰ L-R,with mild valve damage as the main complication and possibility of left ventricular myocardial remodeling.

BACKGROUND:Previous studies have shown that knee joint moment changes in patients with knee osteoarthritis,but there are few reports on the correlation of moment changes with knee extensor muscle strength and gait spatiotemporal parameters. OBJECTIVE:To explore the correlation of knee extensor muscle strength and gait spatiotemporal parameters with peak knee flexion moment and knee adduction moment in female patients with knee osteoarthritis. METHODS:Twenty knee osteoarthritis female patients with single knee disease hospitalized in Guizhou Hospital,Beijing Jishuitan Hospital from February to August 2022 were selected as the knee osteoarthritis group,and an additional 20 healthy females without musculoskeletal disease were selected as the control group.The knee extensor force at 60(°)/s was measured with the Biodex isokinetic instrument.The gait spatiotemporal parameters and peak knee flexion moment and knee adduction moment were collected with the Italian BTS infrared motion capture system and force measuring platform.Pearson correlation analysis was used to explore the correlation of muscle strength and gait spatiotemporal parameters with peak knee adduction moment and knee flexion moment,and the variables significantly related to knee joint moment were further included in the multiple stepwise regression analysis. RESULTS AND CONCLUSION:(1)Compared with the control group,the knee osteoarthritis group had significantly lower knee extensor force,step speed,step frequency,step length,step width,peak knee adduction moment and knee flexion moment at 60(°)/s(P<0.05).(2)Pearson correlation analysis showed that the 60(°)/s centripetal extensor force,step speed,step frequency and step length were positively correlated with the peak knee flexion moment,and negatively correlated with the peak knee adduction moment,with a statistically significant difference(P<0.05).(3)The results of multiple stepwise regression showed that step speed and 60(°)/s knee extensor force were the strongest predictors of peak knee flexion moment,and the total R2 value of the two factors was 0.426,indicating that 42.6%of the total variance of this parameter could be explained.Step length and 60(°)/s centripetal extensor force were the strongest predictors of peak knee adduction moment.The total R2 value of the two factors was 0.602,indicating that 60.2%of the total variance of this parameter could be explained.(4)It is concluded that knee extensor strength,step speed and step length are the main variables affecting peak knee adduction moment and knee flexion moment.Therefore,these variables can be used for clinical gait monitoring and guidance to change knee joint load during knee osteoarthritis rehabilitation.

Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management.

Pain is one of the most common symptoms in cancer patients. Apart from causing patients to suffer from unpleasant feelings and negative emotional experiences, uncontrolled pain may also influence patients' function and quality of life, and may be associated with poorer prognosis. Poor management of chronic cancer-related pain may be related to its complicated mechanisms, limitations of current clinical treatment and clinicians' and patients' insufficient understanding of the symptom. Therefore, this review summarizes the definitions, classifications, evaluation and treatment principles of chronic cancer-related pain, and emphasises the importance of multidisciplinary management and patient education in cancer pain management to provide clinicians with the overall idea of pain management in adult cancer patients.

Infant, Newborn ; Humans ; Infant, Premature ; Infant, Low Birth Weight ; Blood Transfusion ; Infant, Premature, Diseases

The regulatory T cells (Treg) and helper T cells 17 (Th17) play an important role in regulation of the tumor microenvironment in hepatocellular carcinoma (HCC) because Treg/Th17 imbalance was associated with HCC cell invasion and progression. Moreover, the suppressor of cytokine signaling 1 (SOCS1), a negative regulator of the Janus kinase (JAK)/signal transducers and activators of transcription (STAT) pathway, regulates Treg and Th17 proliferation and differentiation. This review summarized and discussed the recent advancement and progress in control of the Treg/Th17 balance in HCC and the immunity-related mechanisms in HCC development and progression, i.e., the SOCS1 structure and functions, SOCS1 role in regulation of Treg/Th17 balance in HCC, and future research direction of the field.

The immune mechanism of chronic hepatitis B (CHB) persistent infection is closely associated with T cells, and the development of T cells requires the coordination of a variety of cytokines. The proteins of the signal transducer and activator of transcription (STAT) family are mainly involved in the signal transduction of cytokines, and STAT5a/b and STAT3 play an important role in the differentiation and development of regulatory T cells (Treg) and T helper 17 cells (Th17). This article analyzes the association of STAT3 and STAT5 with Treg/Th17 balance in CHB and investigates the chronicity of hepatitis B virus infection and the regulatory mechanism of liver inflammation.

Objective:To investigate the anxiety status of patients with myocardial infarction after percutaneous coronary intervention (PCI) and analyze its risk factors.Methods:Using the convenient sampling method, a total of 149 patients with myocardial infarction after PCI who were treated in Lu'an People's Hospital from February 2018 to February 2022 were selected as the research objects. Hamilton Anxiety Rating Scale (HAMA) was used to investigate, and patients were divided into the anxiety group ( n=59) and the non-anxiety group ( n=90) according to HAMA score. Binomial logistic regression analysis was used to explore the risk factors of anxiety in patients with myocardial infarction after PCI. Results:Among 149 patients with myocardial infarction after PCI, the incidence of anxiety was 39.60% (59/149) . The results of binomial logistic regression analysis showed that female, living in rural areas, combined with hypertension, double-vessel or more vascular disease, ejection fraction less than or equal to 50% and payment method of self-pay/new rural cooperative medical system were independent risk factors for anxiety after PCI for myocardial infarction ( P<0.05) . Conclusions:The main risk factors for anxiety in patients with myocardial infarction after PCI included female, living in rural areas, combination with hypertension, double-vessel or more vascular disease, ejection fraction less than or equal to 50%, and payment method of self-pay/new rural cooperative medical system. Clinical nursing staff should focus on high-risk groups and take targeted intervention measures to reduce the risk of anxiety in patients with myocardial infarction after PCI.