1.Analysis of Microbiological and Parasitic Testing Results for Laboratory Animals in Jiangxi Province, 2020-2024
Fangping XIAO ; Lijuan XIONG ; Bo JIA ; Huan LIU ; Yongbing LUO ; Xiaorong WAN
Laboratory Animal and Comparative Medicine 2026;46(1):119-126
Objective To assess the current status of microbial and parasitic quality control for laboratory animals in Jiangxi Province by analyzing microbiological and parasitic test results from production facilities between 2020 and 2024, and to provide a basis for enhancing quality control measures. MethodsIn accordance with the current national standards for laboratory animals at the time of testing, the Jiangxi Provincial Laboratory Animal Quality Inspection Station (affiliated to Institute of Occupational Medicine of Jiangxi) conducted microbial and parasitic testing on 451 laboratory animals of 4 species from 6 laboratory animal production units in Jiangxi Province between 2020 and 2024, and analyzed the quality status of laboratory animals in the province. ResultsPasteurella pneumotropica was detected in one mouse sample in 2020, with a detection rate of 5.00%. Pseudomonas aeruginosa was detected in one mouse sample and mouse hepatitis virus antibody was detected in another mouse sample in 2023, with a detection rate of 2.78%, respectively. No microorganisms or parasites that should be excluded from SPF grade mice as specified in the national standards were detected in 2021, 2022, or 2024, with a qualification rate of 100.00%. Pasteurella pneumotropica was detected in four rat samples in 2020, with a detection rate of 20.00%. Pseudomonas aeruginosa was detected in two rat samples in 2021, with a detection rate of 10.00%, and Tyzzer's disease agent antibody was detected in four rat samples in 2024, with a detection rate of 10.00%. No microorganisms or parasites that should be excluded from SPF grade rats as specified in the national standards were detected in 2022 or 2023, with a qualification rate of 100.00%. For rabbits and guinea pigs, no microorganisms or parasites required to be tested for conventional grade rabbits and guinea pigs as specified in the national standards were detected from 2020 to 2024, with the qualification rate of both species reaching 100.00%. ConclusionBased on the microbial and parasitic testing results, the quality of rabbits and guinea pigs in Jiangxi Province is satisfactory. However, some issues persist with rats and mice. It is recommended to enhance the quality of experimental animals in Jiangxi Province by increasing the frequency of random inspections by quality testing units or by improving the self-inspection capabilities of production and user facilities.
2.Notoginsenoside R1 modulates mitophagy in human cardiomyocytes viathe Pink1/Parkin pathway after hypoxia/reoxygenation
Xiaoman XIONG ; Huan WU ; Shanglin LU ; Yong WANG ; Yuhua ZHENG ; Yi XIANG ; Haiyan ZHOU ; Xingde LIU
Acta Universitatis Medicinalis Anhui 2026;61(1):53-59
ObjectiveTo investigate the mechanism by which Notoginsenoside R1 (NGR1) ameliorates hypoxia/reoxygenation (H/R)-induced injury in AC16 human cardiomyocyte cell lines through the regulation of mitophagy. MethodsCommon genes linked to hypoxia/reoxygenation injury and mitophagy were identified by intersecting data from GeneCards and MitoCarta databases. AC16 cell viability was assessed via CCK-8 assay under varying NGR1 concentrations (0, 6.25, 12.5, 25, 50, 100, 200, 300, 400, 500 μmol/L). AC16 cells were divided into the following groups: control group (Control), model group (H/R), and treatment groups (H/R + NGR1 at 100, 200 and 300 μmol/L). Mitochondrial membrane potential (ΔΨm) was measured using 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolylcarbocyanine iodide (JC-1) staining. Transcriptional levels of mitophagy-related genes (Parkin, Pink1, P62) were quantified by reverse transcription-quantitative PCR (RT-qPCR). Protein expression of mitophagy-related markers (Parkin, Pink1, P62, and LC3BⅡ) was evaluated via Western blot analysis. Mitochondrial ultrastructure was visualized by transmission electron microscopy (TEM). ResultsCompared to the control group, cell viability in the H/R group significantly decreased (P<0.01). Treatment with NGR1 at concentrations above 100 μmol/L significantly enhanced the cell viability of AC16 cells compared to the H/R group (P<0.01). H/R induced a significant decrease in mitochondrial membrane potential (P<0.01), which was restored by NGR1 treatment (P<0.01). The mRNA levels of Parkin, Pink1, and P62 in the H/R group were upregulated compared to the control group (P<0.05), while NGR1 intervention downregulated their expression (P<0.05). Protein expression levels of Parkin, Pink1, and LC3BⅡ in the H/R group significantly increased, while P62 expression decreased compared to the control group (P<0.01). In contrast, different doses of NGR1 treatment significantly reduced the expression of Parkin, Pink1, and LC3BⅡ while increasing P62 expression (P<0.05). TEM revealed that the mitochondrial structure in the H/R group was severely disrupted, with fragmented and disorganized cristae, which was alleviated by NGR1. ConclusionNGR1 ameliorates H/R-induced AC16 cell injury, and its mechanism may be associated with modulating the Pink1/Parkin pathway to suppress excessive mitophagy.
3.Mechanism of Yiqi Huoxue Therapy Regulating IL-33/ST2/IL-1RAP to Improve Nasal Mucosal Tissue Remodeling and Intervene in Allergic Rhinitis
Huan WANG ; Hongping LUO ; Meiya WANG ; Yuyin LIU ; Chenlin WANG ; Chao LIAO ; Fangqi LIANG ; Peizheng XIONG ; Li TIAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):298-307
ObjectiveTo explore the mechanism by which Qidan Yifei Tongqiao granules (QDYF) alleviate nasal mucosal remodeling in allergic rhinitis (AR) via the interleukin-33 (IL-33)/growth stimulation expressed gene 2 (ST2)/interleukin-1 receptor accessory protein (IL-1RAP) signaling pathway from the perspective of Qi-replenishing and blood-activating therapy. MethodsFirst, according to the previous network pharmacology results, this study predicted the potential mechanisms of QDYF in treating AR by screening key pathways, components, and targets. Molecular docking was performed via AutoDock and PyMOL 2.5.5. Subsequently, a rat model of ovalbumin (OVA)-induced AR was used for validation through in vivo experiments. Forty-eight rats were assigned into 6 groups: Control, model, low-dose QDYF (QDYF-L, 4.04 g·kg-1), medium-dose QDYF (QDYF-M, 8.08 g·kg-1), high-dose QDYF (QDYF-H, 16.16 g·kg-1), and loratadine (0.9 mg·kg-1). After 14 days of intervention, behavioral scores of the rats were observed. The morphological changes of nasal mucosa tissue were observed by hematoxylin-eosin (HE) staining. Masson staining was used to observe collagen fiber deposition in the nasal mucosal tissue and to calculate the collagen volume fraction (CVF). The expression of E-cadherin (E-cad) in the nasal mucosa tissue was detected by immunofluorescence. The serum levels of helper T cell 2 (Th2) cytokines interleukin-4 (IL-4), interleukin-5 (IL-5), and interleukin-13 (IL-13) as well as helper T cell 1 (Th1) cytokines interleukin-2 (IL-2) and interferon-γ (INF-γ) were quantified by enzyme-linked immunosorbent assay (ELISA). The protein levels of transforming growth factor-beta 1 (TGF-β1), IL-33, ST2, and IL-1RAP in the nasal mucosa tissue were determined by Western blot. ResultsIL-33, ST2, and IL-1RAP had strong binding ability with the main active ingredients—wogonin, 7-methoxy-2-methylisoflavone, formononetin, naringenin, stigmasterol, and beta-sitosterol of QDYF, with the binding energy < -4.25 kcal⋅mol-1(1 cal≈4.184 J). The results of in vivo experiments showed that compared with the control group, the model group exhibited increased behavioral scores (P<0.05), aggravated pathological damage of nasal mucosa, increased collagen fiber deposition and CVF (P<0.05), elevated serum levels of IL-4, IL-5, and IL-13, up-regulated protein levels of TGF-β1, IL-33, ST2, and IL-1RAP in the nasal mucosa (P<0.05), down-regulated expression of E-cad, and declined serum levels of IL-2, IFN-γ, and IFN-γ/IL-4 ratio (P<0.05). Compared with the model group, the QDYF groups and loratadine group showed reduced behavioral scores (P<0.05), alleviated pathological damage of nasal mucosa, reduced collagen fiber deposition and CVF (P<0.05), and up-regulated E-cad expression (P<0.05). Compared with the model group, the QDYF-H group and the loratadine group showed raised levels of INF-γ and IFN-γ/IL-4 ratio (P<0.05), declined serum levels of IL-4, IL-5, and IL-13, and down-regulated protein levels of TGF-β1, IL-33, ST2, and IL-1RAP in the nasal mucosa (P<0.05). In addition, the QDYF-H group exhibited an elevated serum IL-2 level (P<0.05). The QDYF-M group showed down-regulated protein levels of TGF-β1, IL-33 and IL-1RAP in the nasal mucosa (P<0.05). The QDYF-L group demonstrated a down-regulated protein level of ST2 in the nasal mucosa (P<0.05). ConclusionQDYF may regulate the Th1/Th2 balance through the IL-33/ST2/IL-1RAP signaling pathway, thereby ameliorating nasal mucosal tissue remodeling and alleviating AR.
4.Disorder of phospholipid metabolism in the renal cortex and medulla contributes to acute tubular necrosis in mice after cantharidin exposure using integrative lipidomics and spatial metabolomics
Tianmu HE ; Kexin LIN ; Lijuan XIONG ; Wen ZHANG ; Huan ZHANG ; Cancan DUAN ; Xiaofei LI ; Jianyong ZHANG
Journal of Pharmaceutical Analysis 2025;15(7):1526-1541
Cantharidin(CTD),a natural compound used to treat multiple tumors in the clinic setting,has been limited due to acute kidney injury(AKI).However,the major cause of AKI and its underlying mechanism remain to be elucidated.Serum creatinine(SCr)and blood urea nitrogen(BUN)were detected through pathological evaluation after CTD(1.5 mg/kg)oral gavage in mice in 3 days.Kidney lipidomics based on ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)was used to investigate lipids disorder after CTD exposure in mice.Then,spatial metabolomics based on matrix-assisted laser desorption/ionization-mass spectrometry imaging(MALDI-MSI)was used to detect the kidney spatial distribution of lipids.Integrative analysis was performed to reveal the spatial lipid disorder mechanism and verify key lipids in vitro.The results showed that the levels of SCr and BUN were increased,and tubular necrosis was observed in mouse kidneys,resulting in acute tubular necrosis(ATN)in CTD-induced AKI.Then,lipidomics results revealed that after CTD exposure,232 differential lipid metabolites and 11 pathways including glycerophospholipid(GP)and sphingolipid(SL)metabolism were disrupted.Spatial metabolomics revealed that 55 spatial differential lipid metabolites and nine metabolic pathways were disturbed.Subsequently,integrative analysis found that GP metabolism was stimulated in the renal cortex and medulla,whereas SL metabolism was inhibited in the renal cortex.Up-regulated lysophosphatidylcholine(LysoPC)(18∶2(9Z,12Z)),LysoPC(16∶0/0∶0),glycerophosphocholine,and down-regulated sphingomyelin(SM)(d18∶0/16:0),SM(d 18∶1/24:0),and SM(d42∶1)were key differential lipids.Among them,LysoPC(16∶0/0∶0)was increased in the CTD group at 1.1196 μg/mL,which aggravated CTD-induced ATN in human kidney-2(HK-2)cells.LysoPC acyltransferase was inhibited and choline phos-photransferase 1(CEPT1)was activated after CTD intervention in mice and in HK-2 cells.CTD induces ATN,resulting in AKI,by activating GP metabolism and inhibiting SL metabolism in the renal cortex and medulla,LysoPC(16:0/0:0),LysoPC acyltransferase,and CEPT1 may be the therapeutic targets.
5.Observation on changes of left ventricular systolic function in children with sepsis based on two-dimensional speckle tracking imaging
Ye XIONG ; Huan ZHOU ; Jing PENG ; Xiaoyuan FENG
Chinese Journal of Medical Imaging Technology 2025;41(10):1667-1671
Objective To observe the changes of left ventricular systolic function in children with sepsis by two-dimensional speckle tracking imaging(2D-STI).Methods A total of 29 children with sepsis were retrospectively enrolled and divided into severe sepsis group(n=10)and non-severe sepsis group(n=19)according to relevant diagnostic criteria,while 21 healthy children were taken as controls(control group).Conventional echocardiographic parameters and 2D-STI parameters were compared among 3 groups and between each 2 groups.Results Significant differences of left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD)and right atrial diameter(RAD)were found among 3 groups(all P<0.05),while no significant difference of right ventricular end-diastolic diameter(RVEDD)nor left ventricular ejection fraction(LVEF)was noticed(both P>0.05).Meanwhile,significant differences of left ventricular global longitudinal strain(LVGLS)and basal anterior(BA),basal anterolateral(BAL),basal inferolateral(BIL),mid-anterior(MA),mid-anterolateral(MAL),mid-inferolateral(MIL),apical anterior(APA),apical lateral(APL),apical inferior(API)and apex cap(APEX)segment longitudinal strain(LS)were found among 3 groups(all P<0.05),also of LVGLS between each 2 groups,of LS in BAL,BIL,MA,MAL,MIL,APA,APL,API and APEX segments between severe sepsis group and control group,of LS in BAL and MAL segments between non-severe sepsis group and control group,and of LS in BA,M A,APL,API and APEX segments between severe sepsis group and non-severe sepsis group(all P<0.05).Conclusion Left ventricular 2D-STI parameters in children with sepsis changed when LVEF was still in normal range,and some parameters were related to the severity of disease.
6.Association of Rest-Activity Rhythm With the Risk of Rheumatoid Arthritis and Effect Modification by Genetic Susceptibility
Lele WANG ; Huan XU ; Gonghua WU ; Bing GUO ; Xiong XIAO ; Xing ZHAO ; Juying ZHANG
Journal of Sichuan University (Medical Sciences) 2025;56(3):785-791
Objective To investigate the association between rest-activity rhythm(RAR)and the risks of rheumatoid arthritis(RA),and to evaluate whether genetic susceptibility modifies this relationship.Methods This prospective cohort study utilized data from the UK Biobank,including 88 060 participants who did not have RA at baseline.RAR parameters(e.g.,relative amplitude)were calculated using data obtained through wrist-worn accelerometers.The participants'genetic susceptibility to RA was assessed using a polygenic risk score.Cox proportional hazards models were employed to analyze the association between RAR and RA risk,with interaction terms incorporated to evaluate the effect modification by genetic susceptibility.Results Over a median follow-up period of 7.97 years,660 incident RA cases were identified.After adjusting for age,sex,ethnicity,educational attainment,Townsend deprivation index,drinking status,smoking status,dietary score,body mass index,and polygenic risk score for incident RA,the dose-response analysis revealed a linear relationship between the RAR-related parameters,including the average amplitude during the most active 10 h(M10),interdaily stability(IS),intradaily variability(IV),and the risk of developing RA(P>0.05).In contrast,relative amplitude and the average amplitude during the least active 5 h(L5)showed a nonlinear relationship with the risk of developing RA(P<0.05).Compared to those in the the highest quartile of relative amplitude,participants in the lowest quartile had a 49%increase in the risk of developing RA(hazard ratio[HR]=1.49;95%CI,1.17-1.90).Compared to those in the lowest quartile,participants in the highest quartile of L5 had a 40%increased risk of developing RA(HR=1.40;95%CI,1.12-1.75).Every time M10 increased by one standard deviation,the risk of developing RA decreased by 12%(HR=0.88;95%CI,0.80-0.96).No evidence of effect modification by genetic susceptibility was observed in the RAR-RA association(P>0.05).Conclusion Disrupted rest-activity rhythm is associated with an increased risk of RA,which is independent of genetic susceptibility to RA.Our findings suggest that improving rest-activity rhythm may help reduce RA risks.
7.Study on the safety and pharmacological effect on improving dyspepsia of Shuangshu decoction in rats
Xinyuan CHEN ; Changzhou XIONG ; Jiongfen LI ; Kangyi YU ; Huan XU ; Yingxia WANG ; Dan LIAO ; Junyu TAO ; Ziyi YANG ; Caizhi LIN
China Pharmacy 2025;36(9):1059-1064
OBJECTIVE To study the safety of Shuangshu decoction in rats and its efficacy in improving functional dyspepsia (FD) in rats. METHODS In safety test, 40 rats were divided into blank control group, Shuangshu decoction low-dose, medium- dose and high-dose groups [108, 216, 324 g/(kg·d), calculated by raw medicine, the same applies below]; they were given relevant medicine intragastrically, for continuous 14 days. The mortality and toxic reactions of rats were recorded, and the organ indexes of the liver, kidney, spleen, lung and heart of rats were calculated; the pathological morphological changes in the liver, kidney, spleen, lung, heart, stomach, duodenum, and colon were observed to evaluate the acute toxicity of Shuangshu decoction. Another 40 rats were grouped and administered in the same way for 30 consecutive days. The mortality and toxic reactions of the rats were recorded, and the corresponding organ indexes were calculated. The pathological morphological changes in the corresponding organs were observed, and blood routine and serum biochemical indicators were measured, in order to assess the subacute toxicity of Shuangshu decoction. In pharmacodynamic experiments: 50 rats were divided into blank control group, model group, and Shuangshu decoction low-, medium-, and high-dose groups (9.45, 18.9, 37.8 g/kg), with 10 rats in each group. Except for blank control group, rats in all other groups were used to establish the FD rat model by subcutaneous injection of loperamide (3.5 mg/kg). Rats in each group were administered the corresponding drug solution/normal saline intragastrically, once a day, for 14 consecutive days. After the last medication, fecal moisture content, intestinal propulsion rate, gastric emptying rate and serum level of motilin were all detected, and interstitial cell of Cajal (ICC) ultrastructure of rats was observed in colon tissue. RESULTS The safety experiments showed that no death occurred in each dose group, and no significant difference was found in organ coefficient, routine blood and serum biological index, compared to blank control group (P>0.05); no abnormality was found in organ appearance and pathological sections. The results of the pharmacodynamic experiments showed that, compared with the blank control group, the fecal moisture content, gastric emptying rate, intestinal propulsion rate, and serum motilin levels in the model group were significantly decreased (P<0.05); in the colonic tissue, the mitochondria in the ICC exhibited severe swelling with the disappearance of cristae, and the endoplasmic reticulum was dilated. Compared with model group, the rats in Shuangshu decoction high-dose group showed significant increases in the above quantitative indicators (P< 0.05); additionally, there was a large number of mitochondria in the ICC of the colonic tissue, with clear cristae and regular arrangement. CONCLUSIONS Shuangshu decoction is safe and has a beneficial improving effect on FD rats; its mechanism of action may be related to the regulation of gastrointestinal hormone expression to promote gastric emptying and intestinal propulsion, as well as the repair of mitochondrial structure in ICCs to restore gastrointestinal function.
8.Analysis on allergic diseases from the "lung being responsible for regulating visceral activities"
Huan YU ; Wenyuan GUO ; Yunfei SHUAI ; Leqin XIONG ; Mengqing WANG
International Journal of Traditional Chinese Medicine 2025;47(12):1664-1669
The symptoms of allergic diseases are complex and changeable, and the pathogenesis is complex and difficult to distinguish, and the prevalence of allergic diseases has gradually increased in recent years. Due to the relative limitations of Western medical treatment, in order to further meet the clinical treatment goals, the "lung being responsible for regulating visceral activities" is now used as the theoretical basis, combined with modern medicine, to explore the pathogenesis and etiological mechanism of this disease. Based on the classics, it is proposed that allergic diseases have four characteristics: "onset of allergies, seasonality of disease onset, diversity of symptoms, and recurrence of recovery", and summarized the etiology and pathogenesis as "stagnation of incubative pathogenic factors and disharmony between the nutritive and defensive levels, imbalance of waterways and obstruction of phlegm and dampness, a dysfunction in the pivotal qi flow leading to malnourishment of the skin and hair, the intermingling of cold and heat leads to the dysfunction of the orifices, a disorder of the blood-governing organs leads to extravasation of blood", and advocated that the treatment should take into account the symptoms, syndromes, viscera, and seasons, and clarify the syndromes, which would provide a new research idea for the exploration of the TCM connotation of this disease.
9.Disorder of phospholipid metabolism in the renal cortex and medulla contributes to acute tubular necrosis in mice after cantharidin exposure using integrative lipidomics and spatial metabolomics.
Tianmu HE ; Kexin LIN ; Lijuan XIONG ; Wen ZHANG ; Huan ZHANG ; Cancan DUAN ; Xiaofei LI ; Jianyong ZHANG
Journal of Pharmaceutical Analysis 2025;15(7):101210-101210
Cantharidin (CTD), a natural compound used to treat multiple tumors in the clinic setting, has been limited due to acute kidney injury (AKI). However, the major cause of AKI and its underlying mechanism remain to be elucidated. Serum creatinine (SCr) and blood urea nitrogen (BUN) were detected through pathological evaluation after CTD (1.5 mg/kg) oral gavage in mice in 3 days. Kidney lipidomics based on ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to investigate lipids disorder after CTD exposure in mice. Then, spatial metabolomics based on matrix-assisted laser desorption/ionization-mass spectrometry imaging (MALDI-MSI) was used to detect the kidney spatial distribution of lipids. Integrative analysis was performed to reveal the spatial lipid disorder mechanism and verify key lipids in vitro. The results showed that the levels of SCr and BUN were increased, and tubular necrosis was observed in mouse kidneys, resulting in acute tubular necrosis (ATN) in CTD-induced AKI. Then, lipidomics results revealed that after CTD exposure, 232 differential lipid metabolites and 11 pathways including glycerophospholipid (GP) and sphingolipid (SL) metabolism were disrupted. Spatial metabolomics revealed that 55 spatial differential lipid metabolites and nine metabolic pathways were disturbed. Subsequently, integrative analysis found that GP metabolism was stimulated in the renal cortex and medulla, whereas SL metabolism was inhibited in the renal cortex. Up-regulated lysophosphatidylcholine (LysoPC) (18:2(9Z,12Z)), LysoPC (16:0/0:0), glycerophosphocholine, and down-regulated sphingomyelin (SM) (d18:0/16:0), SM (d18:1/24:0), and SM (d42:1) were key differential lipids. Among them, LysoPC (16:0/0:0) was increased in the CTD group at 1.1196 μg/mL, which aggravated CTD-induced ATN in human kidney-2 (HK-2) cells. LysoPC acyltransferase was inhibited and choline phosphotransferase 1 (CEPT1) was activated after CTD intervention in mice and in HK-2 cells. CTD induces ATN, resulting in AKI, by activating GP metabolism and inhibiting SL metabolism in the renal cortex and medulla, LysoPC (16:0/0:0), LysoPC acyltransferase, and CEPT1 may be the therapeutic targets.
10.The experience of exclusion diet in children with Crohn's disease and their parents:a qualitative study
Lijuan WEI ; Jialin HUANG ; Huan YANG ; Miaoxian ZHANG ; Chaomi ZHANG ; Lanlan GENG ; Liya XIONG ; Liying LIU
Chinese Journal of Nursing 2025;60(17):2131-2136
Objective To explore the experiences of children with Crohn's disease and their parents regarding the exclusion diet,and to provide a basis for formulating personalized dietary guidance programs.Methods A total of 12 children with Crohn's disease and their parents,hospitalized in the Department of Gastroenterology at a tertiary children's hospital in Guangzhou from June to December 2023,were selected as research subjects using objective sampling.Semi-structured interviews were conducted,and the data were analyzed and refined using Colaizzi's seven-step analysis method.Results Totally 3 themes and 14 sub-themes were extracted.①Lack of cognition and trust in Crohn's disease exclusion diet(unfamiliarity with the contents of the diet,misunderstanding of the diet's preparation,inadequate response to daily exclusion diet practices,parents' distrust in the exclusion diet).②The practical challenges of the Crohn's disease exclusion diet(the challenge of personal dietary preferences,the challenge of family meal preparation,the challenge of school feeding,food intolerance,feelings of monotony and weariness following the exclusion diet).③Innovations in practicing the Crohn's disease exclusion diet(managing taste fatigue,managing visual fatigue,innovative cooking methods,prioritizing exclusive enteral nutrition followed by the exclusion diet,overcoming the desire for universal food).Conclusion Children with Crohn's disease and their parents exhibit insufficient cognition and trust in the exclusion diet and face various challenges in practice.Clinical medical staff should adopt personalized coping strategies tailored to the specific circumstances of each child.

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